The visceral adiposity index as a predictor of insulin resistance in young women with polycystic ovary syndrome

Association between visceral adiposity index and cancer risk in the UK Biobank cohort

BACKGROUND

The visceral adiposity index (VAI) is a marker of visceral fat accumulation and metabolic dysfunction, but there is limited evidence of its association with cancer. The objective of this study was to investigate associations between the VAI and both incident cancer at 23 sites and all-cause cancer.

METHODS

In total, 385,477 participants (53.3% women; mean age, 56.3 years) from the UK Biobank prospective cohort were included in this study. The median follow-up was 8.2 years (interquartile range, 7.3-8.9 years). The VAI was calculated using formula the published by Amato et al. and was categorized into sex-specific tertiles. Twenty-four incident cancers were the outcomes. Cox proportional hazard models were adjusted for sociodemographics, lifestyle factors, and multimorbidity counts.

RESULTS

Over the follow-up period, 47,882 individuals developed cancer. In the fully adjusted models, the VAI was associated with a higher risk of six cancer sites. Individuals in the highest tertile, compared with those in the lowest tertile, had higher risks of uterine (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.76-2.49), gallbladder (HR, 1.83; 95% CI, 1.26-2.66), kidney (HR, 1.39; 95% CI, 1.18-1.64), liver (HR, 1.25; 95% CI, 1.00-1.56), colorectal (HR, 1.14; 95% CI, 1.05-1.24), and breast (HR, 1.11; 95% CI, 1.03-1.19) cancers and of all-cause cancer (HR, 1.05). There was no evidence of a nonlinear association between the VAI and cancer risk.

CONCLUSIONS

The VAI was associated with six cancer sites and with all-cause cancer. The prognostic and etiologic roles of visceral fat accumulation and dysfunction in cancer warrant further research.

Fat Distribution and its Correlation with Insulin Resistance, Androgen Markers, and Proinflammatory Cytokines in Polycystic Ovary Syndrome

The high cardiometabolic risk associated with polycystic ovary syndrome (PCOS) may be linked to central fat accumulation. This study compared fat distribution between women with PCOS and controls matched by body mass index. It also sought to determine if insulin resistance (IR), androgens, or inflammatory markers correlate with body composition parameters in PCOS patients. In total, thirty-five women with PCOS and 37 controls, aged 18-40 years, were included. Hormonal/metabolic profiles, inflammatory biomarkers [tumor necrosis factor-alpha (TNF-α and interleukin-6 (IL-6)], anthropometry (waist circumference, waist-to-hip ratio, lipid accumulation product [LAP], visceral adiposity index [VAI]), and body composition assessed through dual-energy X-ray absorptiometry were assessed. The PCOS group exhibited significantly higher androgen levels and markers of IR. However, levels of TNF-α and IL-6 were comparable between the groups. Despite having similar total body fat mass (FM), the PCOS group had excessive central fat, including increased truncal FM and visceral adipose tissue (VAT). In PCOS, androgens were not associated with body fat or its distribution. IL-6 was positively correlated with total and truncal FM, while insulinemia and the homeostatic model assessment for IR were positively associated with VAT, as well as with total and truncal FM. Although anthropometric measurements and indices were positively associated with DXA-derived central FM parameters, our data suggest that LAP is the most effective tool for assessing central fat deposition and metabolic dysfunction in the PCOS patients studied herein. Furthermore, in this population, IR, rather than androgens or proinflammatory cytokines, is more closely associated with abdominal obesity.

Insulin Resistance-Related Cardiometabolic Risk Among Nondiabetic Childbearing Age Females

Background: This study evaluates insulin resistance prevalence in young females without diabetes, assessing risk factors and adiposity indices for early detection of cardiometabolic disorders. Methods: A cross-sectional study was conducted, involving 282 females aged 18-35 years from suburban and rural areas of Sri Lanka. Anthropometric measurements [height, weight, waist circumference (WC)] were obtained and biochemical parameters [fasting glucose, insulin, insulin resistance (IR), total cholesterol, high-density lipoproteins, (HDL), low-density lipoproteins, triglycerides] were measured. The anthropometric and biochemical data were compared between the groups of normal weight controls and overweight/obese cases, as well as between females with or without IR. Results: The prevalence of IR in controls and cases were 48.6% and 57.1%, respectively. Both groups had mean Homeostasis Model Assessment-IR values greater than the normal cutoff value of 2.5. Females with IR showed higher prevalence of dyslipidemia than those without IR. Compared to the controls (2.81%), the prevalence of metabolic syndrome (MetS) was substantially greater among cases (46.42%). Both groups showed a statistically significant association between IR and MetS, but the association was considerably stronger in cases [r = 0.616, odds ratio (OR) >8] than in controls (r = 0.175, OR >1). Controls exhibited lower HDL levels, hypertriglyceridemia, and elevated IR levels (P < 0.05), and their ORs for acquiring MetS were >2, <1, and >3, respectively. Importantly, overweight/obese cases exhibited a significant association (P < 0.05) with all the MetS risk variables. Visceral adiposity index (VAI) proves to be a precise measurement for identifying IR and cardiovascular disease (CVD) among young females (Z = -3.651), surpassing the accuracy of other indices. Body mass index, body round index, a body shape index, and WC were also reliable measurements to assess IR and the risk of CVD (P < 0.05). Conclusion: The study underscores the importance of assessing IR in nondiabetic young females to identify early cardiometabolic risks. VAI emerges as a precise measurement for identifying IR and CVD risk, surpassing the accuracy of other indices.

Triglyceride glucose-related indexes and lipid accumulation products-reliable markers of insulin resistance in the Chinese population

Background

Insulin resistance (IR) is a pivotal pathogenic component of metabolic diseases. It is crucial to identify convenient and reliable indicators of insulin resistance for its early detection. This study aimed at assessing the predictive ability of seven novel obesity and lipid-related indices.

Methods

A total of 5,847 female and 3,532 male healthy subjects were included in the study. The triglyceride glucose (TyG) index, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), lipid accumulation products (LAP), body roundness index (BRI), body adiposity index (BAI), and visceral adiposity index (VAI) were measured and calculated using the established formulae. IR was diagnosed using the homeostatic model assessment of insulin resistance (HOMA-IR) index over the third quantile.

Results

The levels of all seven lipid-related indices were significantly higher in subjects with higher HOMA-IR values than in those with lower HOMA-IR values. These indices displayed moderate to high effectiveness [receiver operating characteristic (ROC) curve-area under the curve (AUC) > 0.6] in predicting IR. Among them, TyG-BMI (AUC: 0.729), LAP (AUC: 0.708), and TyG-WC (AUC: 0.698) showed the strongest association with HOMA-IR. In the female population, the AUC for TyG-BMI, LAP, and TyG-WC in predicting IR was 0.732, 0.705, and 0.718, respectively. Logistic regression analysis showed the optimal cut-off values of those indicators in predicting IR as follows: TyG-BMI: male subjects - 115.16 [odds ratio (OR) = 6.05, 95% CI: 5.09-7.19], female subjects - 101.58 (OR = 4.55, 95% CI: 4.00-5.16); LAP: male subjects - 25.99 (OR = 4.53, 95% CI: 3.82-5.38), female subjects - 16.11 (OR = 3.65, 95% CI: 3.22-4.14); and TyG-WC: male subjects - 409.43 (OR = 5.23, 95% CI: 4.48-6.24), female subjects - 342.48 (OR = 4.07, 95% CI: 3.59-4.61).

Conclusion

TyG-index-related parameters and LAP appear to be effective predictors of IR in the Chinese population. Specifically, TyG-BMI may be the most appropriate predictor of IR.

The association between dietary inflammatory index with some cardio-metabolic risk indices among the patients with type 2 diabetes from Hoveyzeh cohort study: a cross-sectional study

BACKGROUND

The dietary inflammatory index (DII) serves as a tool to assess the inflammatory impact of an individual's diet. This study aimed to investigate the association between DII and some cardio-metabolic risk indices among patients with T2DM.

METHODS

Data from the Hoveyzeh Cohort Study, encompassing 2045 adults with T2DM, were analyzed. DII scores were calculated based on food frequency questionnaires. Anthropometric measurements and biochemical tests were performed to assess cardio-metabolic risk factors.

RESULTS

Higher DII scores were positively associated with elevated triglyceride levels, triglyceride-glucose (TyG) index, lipid accumulation product (LAP), anthropometric indices including a body shape index (ABSI), body roundness index (BRI), body mass index (BMI), hip, waist circumferences (WC), and waist-to-height ratio (all Ptrend < 0.05). Notably, no significant association was observed between DII and fasting blood sugar (FBS) levels (Ptrend > 0.05). Additionally, dietary intake analysis revealed a negative correlation between DII scores and intake of fiber, fruits, vegetables, legumes, fish, seafood, dairy products, magnesium, and vitamins A, C, D, and E (all Ptrend < 0.05). Conversely, higher DII scores were associated with increased consumption of red meat, processed meat, refined cereals, potatoes, and soft drinks (all Ptrend < 0.05).

CONCLUSION

This study underscores the critical link between dietary inflammation, assessed by the DII score, and a multitude of cardio-metabolic risk factors in patients with T2DM. Notably, while the study did not find a significant association between DII and fasting blood sugar levels, it identified robust associations with novel anthropometric and biochemical indices indicative of cardio-metabolic risk. These findings highlight the potential of dietary interventions as a cornerstone strategy for managing T2DM and mitigating its associated complications.

Transition of visceral adiposity index and risk of cardiovascular disease in middle-aged and older Chinese adults

OBJECTIVE

Visceral obesity and the lifetime risk of cardiovascular disease (CVD) have received increasing attention. However, the relationship between dynamic changes in visceral obesity and CVD has not been studied. We aimed to determine the association of visceral adiposity index (VAI) transition with CVD risk.

METHODS

A total of 5395 participants were recruited in 2011-2012 and followed up until 2018 from the China Health and Retirement Longitudinal Study. The cut-off value of the VAI was obtained by the receiver-operating characteristic curve. Participants were grouped based on VAI change patterns during the follow-up period (2011-2015): the low-low group, low-high group, high-low group, and high-high group. CVD was defined as a medical diagnosis of heart disease and/or stroke. A Cox proportional hazards model was used to evaluate the correlation between VAI transition and CVD.

RESULTS

Over a median follow-up period of 7 years, 969 participants (17.9 %) developed CVD. VAI change patterns were significantly associated with CVD risk after adjustment for demographic characteristics and risk factors. The high-high group (hazard ratio (HR): 1.65, 95 % confidence interval (CI): 1.39-1.97) and the low-high group (HR: 1.29, 95 % CI: 1.04-1.61) were associated with a higher risk of CVD after adjusting for demographic characteristics and traditional risk factors compared to the low-low group, while the effect in the high-low group was not significant.

CONCLUSIONS

VAI transition was significantly associated with the risk of CVD. Monitoring the dynamics of the VAI in public health practice would help prevent CVD.

Lipid accumulation product and visceral adiposity index for incidence of cardiovascular diseases and mortality; results from 13 years follow-up in Isfahan cohort study

Background

/Aims: Visceral adiposity index (VAI) and lipid accumulation product (LAP) are novel anthropometric indices that have shown an association with metabolic syndrome; however, limited data are available regarding the predictive performance of these indices for the incidence of cardiovascular diseases (CVD) and mortality.

Methods

This study was performed on the data retrieved from Isfahan Cohort Study (ICS). ICS is an ongoing population-based cohort study conducted in 3 counties in central Iran. Pearson correlation analysis was performed between LAP, VAI, and metabolic parameters. Cox regression analysis and receiver operative characteristics (ROC) curve analysis were performed in order to evaluate the ability of VAI and LAP for the incidence of CVD, CVD-associated mortality, and all-cause mortality. We further compared the predictive performance of VAI and LAP with body mass index (BMI).

Results

LAP and VAI were significantly correlated with all metabolic variables, including blood pressure, fasting blood glucose, and lipid profile components. Univariate regression analysis indicated a significant association between LAP and VAI and CVD incidence. In multivariate analysis, only VAI was significantly associated with CVD incidence. Regarding CVD mortality, only VAI in the multivariate analysis revealed a significant association. Interestingly, Both VAI and LAP were negatively associated with all-cause mortality. ROC curve analysis indicated the superior performance of LAP and VAI for predicting CVD incidence compared to BMI; however, BMI was better in predicting all-cause mortality.

Conclusion

Compared to BMI, LAP and VAI have better predictive performance for the incidence of CVD. In contrast, BMI was superior to VAI and LAP in the prediction of all-cause mortality.

Utility of Visceral Adiposity Index and Lipid Accumulation Products to Define Metabolically-Unhealthy Polycystic Ovary Syndrome in Asian Indian Women - A Cross Sectional Study

Background

Polycystic ovary syndrome (PCOS) women are at risk of developing diabetes, cardiovascular disease and metabolic syndrome (MetS) due to insulin resistance (IR) and hyperandrogenism (HA). Both visceral adiposity index (VAI) and lipid accumulation product (LAP) are simple outpatient department-based metric tools that have been introduced to screen PCOS women who are metabolically unhealthy and are at risk of development of MetS.

Aims

The aim of the study was to evaluate VAI and LAP in women with PCOS and to correlate them with metabolic and endocrine markers. The study also assessed these parameters amongst different PCOS phenotypes and determined their usefulness to define metabolically healthy PCOS (MH-PCOS) and metabolically unhealthy PCOS (MU-PCOS).

Settings and Design

The design of the study was a cross-sectional study.

Materials and Methods

Two hundred PCOS women were included in the study, and all the clinical, anthropometric, hormonal, biochemical and metabolic markers were assessed. The cohort was divided into MH-PCOS and MU-PCOS by the modified National Cholesterol Education Programme criteria. VAI and LAP were calculated and correlated with clinical, endocrine and metabolic parameters.

Statistical Analysis Used

Univariate and multivariate logistic regression analysis was used to study the independent role of VAI and LAP to predict MetS. Adjusted and unadjusted odds ratios were calculated. Receiver-operating characteristic (ROC) analysis was done to define cut-offs in Asian Indian women.

Results

VAI and LAP had good ability to correctly discriminate MU-PCOS from MH-PCOS (area under the curve [AUC] [95% confidence interval (CI)]: 0.89 [0.82-0.95]) and (AUC [95% CI [0.81-0.92] =0.86) using ROC, respectively. The sensitivity of VAI and LAP corresponding to the optimal cut-off of ≥2.76 and ≥48.06 (Youden) was 84.09% and 79.55%, respectively. Similarly, the specificity of VAI and LAP was 85.26% and 79.49%, respectively. VAI has a positive predictive value of 61.7% (95% CI [23.7%-40.3%]) and a negative predictive value of 95% (95% CI [88%-99.1%]). LAP has a positive predictive value of 53% (95% CI [40.3%-65.4%]) and a negative predictive value of 93.3% (95% CI [87.6%-96.9%]). PCOS women having VAI ≥ 2.76 had 19.3 times ([95% CI: 6.50-57.70]) more chance of developing MetS. PCOS women having LAP (≥48.06) have 3.7 times ([95% CI: 1.35-10.60]) more odds. There was no difference between ROC curves of VAI and LAP (P = 0.32).

Conclusion

VAI cut-off ≥ 2.76 and LAP with a cut-off of ≥ 48.06 may be used as markers for predicting MetS amongst PCOS women.

Prolactin in Polycystic Ovary Syndrome: Metabolic Effects and Therapeutic Prospects

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine and metabolic disorder in premenopausal women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Patients frequently present comorbidities, including obesity, insulin resistance, and impaired glucose and lipid metabolism. The diverse clinical presentation may mimic various endocrine disorders, making the diagnosis challenging in some clinical circumstances. Prolactin (PRL) is a recommended biomarker in the initial diagnostic workup to rule out hyperprolactinemia (HPRL). The traditional role of PRL is linked to lactation and the reproductive system. Recent research highlights PRL's emerging role in metabolic homeostasis. PRL influences metabolism directly by interacting with the pancreas, liver, hypothalamus, and adipose tissue. Its influence on an individual's metabolism is intricately tied to its serum concentration. While deficient and very high levels of PRL can negatively affect metabolism, intermediate-normal to moderately high levels may promote metabolic health. In women with PCOS, PRL levels may be altered. Research results on different aspects of the relationship between PCOS and the impact of various levels of PRL on metabolic homeostasis are limited and inconsistent. In this narrative literature review, we comprehensively examined data on serum PRL levels in PCOS patients. We investigated the correlation between a favorable metabolic profile and serum PRL levels in this population. Furthermore, we explored the concept of beneficial PRL effects on metabolism and discussed the potential therapeutic application of dopamine agonists in PCOS treatment. Lastly, we emphasized several promising avenues for future research in this field.

Associations of lipid accumulation product, visceral adiposity index, and triglyceride-glucose index with subclinical organ damage in healthy Chinese adults

Background and aims

Obesity is an independent risk factor for cardiovascular disease development. Here, we aimed to examine and compare the predictive values of three novel obesity indices, lipid accumulation product (LAP), visceral adiposity index (VAI), and triglyceride-glucose (TyG) index, for cardiovascular subclinical organ damage.

Methods

A total of 1,773 healthy individuals from the Hanzhong Adolescent Hypertension Study cohort were enrolled. Anthropometric, biochemical, urinary albumin-to-creatinine ratio (uACR), brachial-ankle pulse wave velocity (baPWV), and Cornell voltage-duration product data were collected. Furthermore, the potential risk factors for subclinical organ damage were investigated, with particular emphasis on examining the predictive value of the LAP, VAI, and TyG index for detecting subclinical organ damage.

Results

LAP, VAI, and TyG index exhibited a significant positive association with baPWV and uACR. However, only LAP and VAI were found to have a positive correlation with Cornell product. While the three indices did not show an association with electrocardiographic left ventricular hypertrophy, higher values of LAP and TyG index were significantly associated with an increased risk of arterial stiffness and albuminuria. Furthermore, after dividing the population into quartiles, the fourth quartiles of LAP and TyG index showed a significant association with arterial stiffness and albuminuria when compared with the first quartiles, in both unadjusted and fully adjusted models. Additionally, the concordance index (C-index) values for LAP, VAI, and TyG index were reasonably high for arterial stiffness (0.856, 0.856, and 0.857, respectively) and albuminuria (0.739, 0.737, and 0.746, respectively). Lastly, the analyses of continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) demonstrated that the TyG index exhibited significantly higher predictive values for arterial stiffness and albuminuria compared with LAP and VAI.

Conclusion

LAP, VAI, and, especially, TyG index demonstrated utility in screening cardiovascular subclinical organ damage among Chinese adults in this community-based sample. These indices have the potential to function as markers for early detection of cardiovascular disease in otherwise healthy individuals.

Visceral adiposity index and the risk of heart failure, late-life cardiac structure, and function in ARIC study

BACKGROUND

It is well established that obesity is associated with the risk of heart failure (HF). However, the data about relationship between visceral fat and the risk of HF are limited.

AIMS

We aim to evaluate the association between visceral obesity assessed by visceral adiposity index (VAI) and incident HF and left ventricular (LV) structure and function in Atherosclerosis Risk in Communities (ARIC) study.

METHODS

We included 12 161 participants (aged 54.1 ± 5.8 years) free of history of HF and coronary heart disease at baseline (1987-89) in ARIC study. We used multivariable Cox hazard regression models to assess the association between the VAI and incident HF. We further explored the effects of the VAI on LV geometry and function among 4817 participants with echocardiographic data using multivariable linear regression analysis and multinomial logistic regression.

RESULTS

During a median follow-up of 22.5 years, a total of 1904 (15.7%) participants developed HF. After adjustment for traditional HF risk factors, 1 unit increase in the baseline VAI was associated with an 8% higher risk of incident HF [hazard ratio (HR): 1.08, 95% confidence interval (CI): 1.06-1.11]. Results were similar when participants were categorized by VAI tertiles. Compared with participants in the lowest tertile of VAI, those in the second tertile and third tertile had a greater risk of incident HF [HR (95% CI): 1.19 (1.05-1.34) and 1.42 (1.26-1.61), respectively]. For the analyses of the HF subtypes, the higher VAI was only associated with the risk of HF with preserved ejection fraction, not with HF with reduced ejection fraction. In addition, the greater VAI was associated with worse LV diastolic function and abnormal LV geometry including concentric remodelling, concentric hypertrophy, and eccentric hypertrophy.

CONCLUSION

This study shows that higher VAI was independently associated with the increased risk of incident HF and abnormal LV geometry and LV diastolic dysfunction.

Is Metabolic Score for Visceral Fat (METS-VF) a Better Index Than Other Adiposity Indices for the Prediction of Visceral Adiposity

Background

Visceral adiposity is an important risk factor for cardiometabolic diseases.

Objective

To determine whether the Metabolic Score for Visceral Fat (METS-VF) is more effective than other adiposity indices in predicting visceral fat area (VFA).

Methods

In this single-center and cross-sectional study, we included patients aged 20-50 years, without diabetes and coronary artery disease, who underwent computed tomography (CT) including the third lumbar vertebra. Age, blood pressure, waist circumference (WC), hip circumference, fasting lipids, and glucose were assessed. VFA was measured by cross-sectional examination of CT. The correlation of WC, body mass index (BMI), waist-hip ratio (WHR), lipid accumulation product (LAP), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), and METS-VF with VFA was analyzed by correlation analysis. The cut-off values and area under the curve (AUC) for identifying increased VFA (>130 cm2) were determined.

Results

We included 185 individuals with mean age 38.2 ± 8 and female predominance (58.4%). There was a significant positive correlation between all indices and VFA (p<0.001). ROC analysis revealed that METS-VF and WC demonstrated the highest predictive value for identifying increased VFA. In both men (p=0.001) and women (p<0.001), METS-VF (AUC 0.922 and 0.939, respectively) showed a significant superiority over ABSI (AUC 0.702 and 0.658, respectively), and VAI (AUC 0.731 and 0.725, respectively). Additionally, in women, its superiority over WHR (AUC 0.807) was also statistically significant (p=0.003). We identified a METS-VF cut-off point >6.4 in males >6.5 in females and WC cut-off point >88 cm in males (AUC 0.922), >90.5 cm in females (AUC 0.938).

Conclusion

METS-VF is strongly associated with visceral adiposity and better to predict increased VFA. However, its superiority over WC, BMI, BRI, and LAP was not significant. The results emphasize that WC is more appealing as screening indicator for visceral adiposity considering its easy use.

Clinical Trial Registry Name

Clinicaltrials.gov (http://www.clinicaltrials.gov).

Clinical Trial Registry Url

https://clinicaltrials.gov/ct2/show/NCT05648409.

Clinical Trial Registry Number

NCT05648409.

Abdominal Obesity in Women with Polycystic Ovary Syndrome and Its Relationship with Diet, Physical Activity and Insulin Resistance: A Pilot Study

Abdominal obesity is a common feature of women with polycystic ovary syndrome (PCOS), and it is known to exacerbate insulin resistance (IR). Improper dietary and physical activity patterns are crucial environmental factors involved in the development of obesity, and they can significantly influence the central deposition of adipose tissue. Therefore, in this cross-sectional study, we aimed to evaluate the relationship between abdominal adiposity (measured by VAT (visceral adipose tissue), SAT (subcutaneous adipose tissue), VAT/SAT ratio (visceral to subcutaneous fat ratio), and WHR (waist-to-hip ratio)) and the prevalence and odds ratios of IR (measured by the homeostatic model assessment of insulin resistance (HOMA-IR), the homeostatic model assessment-adiponectin (HOMA-AD) and leptin to adiponectin ratio (L/A ratio)) in 56 PCOS women. Furthermore, we investigated the relationship between these abdominal obesity indices and diet and physical activity. An original food frequency questionnaire and Actigraph GT3X-BT were used to assess adherence to the diet recommended in IR and the level of physical activity, respectively. We observed a higher prevalence of IR among women with higher VAT, VAT/SAT, and WHR values compared to women with normal values of those abdominal obesity indices. Moreover, VAT/SAT seemed to be the best predictor of IR measured by HOMA-IR and HOMA-AD. However, VAT appeared to be the best and strongest predictor of IR measured by the L/A ratio. We also observed that higher adherence to the diet recommended in IR and higher levels of vigorous physical activity were associated with lower values of central fat accumulation indices and a greater chance of their normal values. Our findings indicate that central obesity increases the odds of IR and supports the beneficial role of diet and physical activity in the management of abdominal obesity in PCOS women.

Comparison of insulin resistance indices in predicting albuminuria among patients with type 2 diabetes

PURPOSE

Diabetes is the leading cause of kidney disease. Up to 40% of the population with diabetes experience diabetic kidney disease (DKD). The correlation of DKD with insulin resistance (IR) indices has been shown in previous studies. In this study, the objective was to evaluate surrogate IR indices, including the Triglyceride-Glucose (TyG) index, Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to find the most valuable index for the correlation between albuminuria and IR in the type 2 diabetes (T2D) population. Albuminuria is defined as urine albumin excretion of > 30 mg/day.

METHODS

In this cross-sectional study, 2934 participants were enrolled and evaluated for urinary albumin excretion, and albuminuria was detected in 526 of the entries. The logistic regression models and Receiver Operating Characteristic (ROC) curve analysis were performed to assess the relationship of TyG index, VAI, LAP, and HOMA-IR's with albuminuria in patients with T2D.

RESULTS

The TyG index had the highest association (OR 1.67) with the presence of albuminuria in patients with T2D, followed by HOMA-IR (OR 1.127), VAI (OR 1.028), and LAP (OR 1.004). These four indices remained independent after adjustment for multiple confounders. Based on the ROC curve, TyG revealed the best area under the curve (AUC) for revealing albuminuria with sufficient accuracy (AUC: 0.62) in comparison with other measured indices. The calculated TyG index cut-off point for the presence of albuminuria was 9.39.

CONCLUSION

Among the indices, TyG index had the most significant correlation with albuminuria in patients with T2D.

Association of the visceral adiposity index with arterial stiffness in elderly Chinese population

BACKGROUND

The visceral adiposity index (VAI) is a new marker of adipose dysfunction and related with cardiometabolic risk. The aim of this study is to investigate the association of VAI with arterial stiffness in elderly Chinese population.

METHODS

A total of 1,707 elderly individuals over 60 years of age were recruited for this cross-sectional study. We measured body composition, anthropometrics, blood pressure, and lipid parameters. The arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV) and defined as baPWV ≥ 1400 cm/s. VAI‬ was calculated based on body mass index, waist circumference, triglyceride and high-density lipoprotein cholesterol. Multivariable regression analysis was performed to evaluate the association between VAI and baPWV.

RESULTS

There were significant differences in VAI tertiles between low-baPWV and high-baPWV group (p = 0.008). Univariate analysis demonstrated that age, history of hypertension, SBP, DBP, total cholesterol, fasting glucose, the higher VAI tertiles were correlated with the existence of high-baPWV (p < 0.05). Participants in the higher VAI tertiles had higher OR (1.0 ≤ VAI < 1.74: OR= 2.89, 95% CI [1.44, 5.80]; VAI ≥ 1.75: OR = 4.23, 95% CI [1.45, 12.37], p for trend: 0.004) comparing with the lowest VAI tertile. Non-linear relationship was detected between VAI and baPWV. VAI was positively correlated with baPWV when VAI < 2.10.

CONCLUSIONS

This study demonstrates that VAI is independently associated with the risk of arterial stiffness in elderly population.

The Visceral Adiposity Index (VAI) and Lipid Accumulation Product (LAP) Are Predictors of Insulin Resistance and Hyperandrogenaemia in Obesity/Overweight Women with Polycystic Ovary Syndrome

Objective

Hyperandrogenaemia and insulin resistance (IR) are the main characteristics of polycystic ovary syndrome (PCOS). Here, we study to find appropriate markers predicting IR and hyperandrogenaemia of women with PCOS in northwest China.

Methods

According to body mass index (BMI), 953 patients with PCOS were divided into two groups. All the patients underwent physical examination and ultrasonography and collected elbow vein blood. Their BMI, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), LAP, VAI, homeostasis model assessment index of insulin resistance (HOMA-IR), and free androgen index (FAI) were calculated. Each group (normal weight and obesity/overweight) was further divided into two subgroups according to their HOMA-IR and FAI: the IR+ subgroup/IR- subgroup and FAI+ subgroup/FAI- subgroup. Furthermore, we compared the clinical indices, hormone levels, and metabolic makers separately between these groups. The correlations between these parameters and HOMA-IR or FAI were tested; sensitivity, specificity, and receiver-operating characteristic (ROC) curves were calculated.

Results

In the obesity/overweight group, the VAI (best cut-off value: 2.27, area under the curve (AUC) = 0.699) and LAP (best cut-off value: 45.54, AUC = 0.680) were sensitive predictors of IR (sensitivity = 72% and sensitivity = 67%). Additionally, the VAI (best cut-off value: 2.13, AUC = 0.624) and LAP (best cut-off value: 51.18, AUC = 0.582) were sensitive predictors of FAI (sensitivity = 87% and sensitivity = 64%). In the normal weight group, BMI could preferably predict HOMA-IR (AUC = 0.717, best cut-off value: 21.62) and HOMA-IR could preferably predict FAI (best cut-off value: 2.11, AUC = 0.648).

Conclusion

Our data indicated that the VAI and LAP may contribute to the early identification of IR and hyperandrogenaemia in the obesity/overweight patients of PCOS. In normal weight PCOS, BMI was a better predictor to IR, and HOWA-IR was a better predictor to FAI.

Diabetes Mellitus Type 2 Patients with Abdominal Obesity Are Prone to Osteodysfunction: A Cross-Sectional Study

Introduction

The interaction between diabetes, obesity, and bone metabolism was drawing increasing public attention. However, the osteometabolic changes in diabetes mellitus type 2 (T2DM) patients with abdominal obesity have not been fully revealed. This study is aimed at investigating the association between abdominal obesity indices and bone turnover markers among T2DM participants.

Methods

4351 subjects were involved in the METAL study. Abdominal obesity indices included neck, waist, and hip circumference, visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), and Chinese visceral adiposity index (CVAI). They were applied to elucidate the nexus between β-C-terminal telopeptide (β-CTX), osteocalcin (OC), and intact N-terminal propeptide of type I collagen (P1NP).

Results

Abdominal obesity indices were strongly negatively associated with β-CTX and OC. Among males, five indices were negatively correlated with β-CTX (BMI, WC, LAP, WHR, and CVAI) and OC (BMI, NC, WC, WHR, and CVAI). There were no significant associations with P1NP. Among females, all eight indices were negatively associated with β-CTX. Seven indices were negatively related to OC (BMI, NC, WC, HC, LAP, WHR, and CVAI). The VAI was negatively correlated with P1NP.

Conclusions

The present study demonstrated that in T2DM, abdominal obesity had an obviously negative correlation with bone metabolism. Abdominal obesity indices were significantly negatively associated with skeletal destruction (β-CTX) and formation (OC). In routine clinical practice, these easily obtained indices could be used as a preliminary screening method and relevant factors for osteodysfunction incidence risk at no additional cost and may be of particular value for postmenopausal women in T2DM populations.

Sex-specific trajectories of insulin resistance markers and reduced renal function during 18 years of follow-up; TLGS

OBJECTIVE

To investigate the association between the dynamic course of insulin resistance and chronic kidney disease (CKD).

METHODS

In a longitudinal population-based Tehran Lipid and Glucose Study, 3071 eligible participants aged ≥20 years were followed for 18 years at three-year intervals. HOMA-IR and clinical surrogate markers of insulin resistance, including triglyceride-glucose index (TyG), visceral adiposity index (VAI), and lipid accumulation product (LAP), were calculated. Using latent variable mixture modeling, sex-specific trajectories were plotted for each insulin resistance marker. Trajectory group association of the insulin resistance markers with CKD was determined using the multivariate cox proportional hazards regression model.

RESULTS

For HOMA-IR, two distinct trajectory patterns (stable and increasing), and for TyG, VAI, and LAP, three trajectories (low, moderate, high) were identified. The participants with increasing HOMA-IR trajectory had a significantly increased risk of CKD in men (HR: 1.72, 95%CI: 1.06-2.79) and women (HR: 1.37, 95%CI: 1.00-1.89) after adjusting confounding variables. The high TyG and VAI trajectory classes were associated with a higher risk of CKD than the low TyG and VAI trajectory classes in both men (TyG: HR:1.97, 95%CI: 1.12-3.46; VAI: HR:1.66, 95%CI:1.06-2.62) and women (TyG: HR:1.50, 95%CI:1.06-2.12; VAI: HR:1.66, 95%CI:1.20-2.31). In contrast, the High LAP (HR: 3.38, 95%CI: 2.08-5.48) trajectory was associated with incident CKD only in women.

CONCLUSION

An increasing trend of HOMA-IR is associated with a higher risk of CKD in men and women. Among clinical insulin resistance surrogate markers, abnormal trajectory patterns of LAP in women and TyG and VAI in both sexes are associated with a higher risk of CKD.

Evaluation of novel obesity- and lipid-related indices as predictors of abnormal glucose tolerance in Chinese women with polycystic ovary syndrome

PURPOSE

We aimed to evaluate the performance of Chinese visceral adiposity index (CVAI), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride glucose (TyG) as indices in screening abnormal glucose tolerance (AGT) in Chinese women with polycystic ovary syndrome (PCOS), using the oral glucose tolerance test (OGTT) as a reference test. In addition, we essentially compared the abilities of these indices with body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG).

MATERIALS AND METHODS

All 1113 PCOS patients evaluated in this study underwent OGTTs. The 2-h post-oral glucose load (2 h-PG) level was used to categorize subjects into two groups: those having AGT or normal glucose tolerance (NGT) levels.

RESULTS

A statistically significant positive correlation between levels of 2 h-PG and FPG, BMI, WC, LAP, VAI, CVAI, TyG, (P < 0.05), was observed. The strongest correlation was found between the levels of 2 h-PG and CVAI (r = 0.47). The CVAI provided the highest area under the receiver-operating characteristic curve (AUC) for AGT, followed by LAP, BMI, TyG, VAI, WC, and FPG. The CVAI of 32.61 (with AUC: 0.76, sensitivity: 73%, specificity: 70%, positive preductive value (PPV): 0.41, negative predictive value (NPV): 0.90) was found to be the cut-off point for AGT in Chinese women with PCOS.

CONCLUSIONS

CVAI may not reliably detect AGT in Chinese women with PCOS. However, it is suitable as a first screening indicator to guide physicians to ordering OGTT.

Metabolik sendrom, insülin direnci, diabetes mellitus ve hipertansiyonu öngörmede visseral adipozite indeksi kesme değerlerinin belirlenmesi

Introduction: The visceral adiposity index is a reliable indicator of visceral adipose tissue dysfunction. The aim of this research was to determine the cut-off points of the visceral adiposity index in predicting metabolic syndrome, insulin resistance, type 2 diabetes mellitus, and hypertension at specific age ranges and in both sexes separately.Methods: This research is both descriptive and analytical. The research was conducted with 951 participants aged 18 and over between July 2019 and July 2020. 51 participants that did not meet study criteria were excluded from the research. The research was completed with a total of 900 participants, 577 females and 373 males. A physical examination and anthropometric measurements (height, weight, waist circumference, and blood pressure) of all participants were conducted. After 12 hours of fasting, the HDL, TG, glucose, and insulin levels of participants were measured. The blood pressure of participants was measured after 15 minutes of rest. Adult treatment panel 3 criteria were used for the diagnosis of metabolic syndrome. A homeostatic model assessment was calculated. The visceral adiposity index is calculated in the entire population for the prediction of metabolic syndrome, insulin resistance, diabetes, and hypertension: women, men, age groups 18–30, 31–40, 41–50, 51–65, 66 and over.Results: Cut-off points of the visceral adiposity index in predicting metabolic syndrome were 4.53 in the total population and males, 4.28 in females, 4.76 in the 18-30 age range, 4.96 in the 31-40 age range, 4.87 in the 41-50 age range, 5.04 in the 51-65 age range, and 4.59 in the age range 66 and above. Cut-off points of the visceral adiposity index in predicting insulin resistance were 4.24 in the total population and females, 4.68 in males, 3.45 in the 18-30 age range, 4.15 in the 31-40 age range, 4.66 in the 41-50 age range, and 4.87 in the 51-65 age range. Cut-off points of the visceral adiposity index in predicting type 2 diabetes mellitus were 4.89 in the total population, 6.43 in females, 7.02 in the 31-40 age range, 7.29 in the 41-50 age range, and 5.98 in the 51-65 age range. Cut-off points of the visceral adiposity index in predicting hypertension were 4.26 in the total population, 4.07 in females, 4.64 in the 18–30 age range, and 4.43 in the 51–65 age range.Conclusions: The visceral adiposity index can be used to predict metabolic syndrome, insulin resistance, type 2 diabetes mellitus and hypertension.

Predictive Effect of Triglyceride Glucose-Related Parameters, Obesity Indices, and Lipid Ratios for Diabetes in a Chinese Population: A Prospective Cohort Study

Objective

The purpose of this study was to evaluate the association between triglyceride glucose (TyG) index and new-onset diabetes under different glycemic states and to compare the predictive value of TyG-related parameters, obesity indices, and lipid ratios for new-onset diabetes.

Methods

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS), consisting of 6,258 participants aged ≥45 years. Participants were grouped according to their glycemic states. Cox proportional hazards models and restricted cubic spline regression were used to explore the association between TyG index and diabetes. Cox proportional hazard models were applied to confirm the predictive value of the optimal marker. Receiver operating characteristic (ROC) curves were used to compare the predictive value.

Results

TyG index was positively correlated with the risk of diabetes (hazard ratio (HR), 1.75; 95% confidence interval (CI), 1.56-1.97), and the linear association existed (p < 0.001). The highest correlation with diabetes was visceral adiposity index (VAI) (HR, 2.04; 95% CI, 1.44-2.90) in normal fasting glucose (NFG) group and TyG-body mass index (TyG-BMI) (HR, 2.53; 95% CI, 1.97-3.26) in impaired fasting glucose (IFG) group. The largest area under curve (AUC) was observed in TyG-waist-to-height ratio (TyG-WHtR) in the NFG group (AUC, 0.613; 95% CI, 0.527-0.700), and TyG-BMI had the highest AUC in the IFG group (AUC, 0.643; 95% CI, 0.601-0.685).

Conclusion

The association between TyG index and new-onset diabetes was positive and linear. TyG-WHtR was a clinically effective marker for identifying the risks of diabetes in the NFG group and TyG-BMI was an effective marker to predict diabetes in the IFG group.

The visceral adiposity index and risk of type 2 diabetes mellitus in China: A national cohort analysis

AIMS

Visceral Adiposity Index (VAI) is a sex-specific index of visceral adiposity based on body mass index, waist circumference, triglycerides and high-density lipoprotein cholesterol. This study aims to demonstrate the association of VAI and its longitudinal transition patterns with type 2 diabetes mellitus (T2DM) in middle-aged and older Chinese.

MATERIALS AND METHODS

Data from the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018) were analysed. Participants were classified into high- and low-VAI groups at baseline, and subsequently into four transition patterns during follow-up (2011-2015): maintained-high, maintained-low, high-to-low, and low-to-high VAI. Multivariable Cox frailty models with random effects were used to assess the associations of VAI and its transitions with T2DM.

RESULTS

A total of 7245 participants were analysed, among which 818 developed T2DM by 2018. A positive association between baseline high-VAI levels and T2DM was observed (HR = 1.49, 95% CI: 1.27-1.75). Compared with people with maintained low-VAI pattern during follow-up, those with transition patterns of maintained-high VAI, high-to-low VAI, and low-to-high VAI were at higher risk of T2DM (HR = 1.97, 1.52, and 1.56, respectively, all p < 0.05). The risk of T2DM decreased significantly in the high-to-low VAI group as compared to the maintained-high VAI group (HR = 0.77, 95% CI: 0.60-0.99).

CONCLUSIONS

This study demonstrated the significant associations of baseline VAI and its transitions with the risk of new-onset T2DM. Early prevention efforts are needed to control the development of T2DM in Chinese with high-VAI levels.

Effect of Exercise Training on Spexin Level, Appetite, Lipid Accumulation Product, Visceral Adiposity Index, and Body Composition in Adults With Type 2 Diabetes

ObjectiveTo compare the effects of resistance and aerobic training (RT and AT) on spexin (SPX), appetite, lipid accumulation product (LAP), visceral adiposity index (VAI), and body composition in type 2 diabetes mellitus (T2DM) patients. Materials and Methods: Thirty-six T2DM men were randomized to receive RT (n = 12), AT (n = 12), or to act as a non-exercise control (CON, n = 12) 3 days a week for 12 weeks. Results: SPX was increased after both RT and AT (66.2% and 46.5%, respectively). VAI, LAP, and homeostasis model assessment-insulin resistance (HOMA-IR) were reduced in both groups, while quantitative insulin sensitivity check index (Quicki) and McAuley's indexes were increased following both interventions. However, the increases of both hunger and PFC in the RT group were greater than those of the AT. Moreover, the improvement of upper-body strength (41% vs. 10.3%) and lower-body strength (42.2% vs. 20.5%) in the RT group was greater than those of the AT. Conclusion: Our investigation shows that regardless of the modes of the regimen, a 12-week exercise intervention with RT and AT can effectively induce a significant improvement in SPX levels, appetite, LAP, VAI, and body composition in adults with T2DM.

Visceral adiposity index is associated with arterial stiffness in hypertensive adults with normal-weight: the china H-type hypertension registry study

Background

Limited information is available on arterial stiffness risk among hypertensive patients with metabolically abnormal but normal weight. Visceral adiposity index (VAI) is a novel indicator for visceral fat mass and metabolism, however, whether can be used to assessed arterial stiffness in a normal-weight population remains unclear. The goal of this study was to examine the independent association of VAI with arterial stiffness in normal-weight hypertensive patients.

Methods

3258 participants recruited from the China H-type Hypertension Registry Study. VAI value was calculated using sex-specific equations. High arterial stiffness was defined as baPWV ≥ 18 m/s. Multivariable regression analysis was used to identify the association of VAI with baPWV and high arterial stiffness.

Results

Of participants, 50.5% (1644) were males, the mean age was 65.5 (SD, 9.1) years. Mean VAI and baPWV were 2.0 (SD, 2.3) and 18.2 (SD, 3.9) m/s, respectively. For each unit increase of lg VAI in multivariable regression analysis, there was a 1.05 m/s increase in baPWV (95% CI 0.67, 1.43) and a 2.13-fold increase in the risk of high arterial stiffness (95% CI 1.59, 2.86). In all models, the VAI was consistently and significantly associated with baPWV after adjustment for different confounders. High VAI levels were stably associated with baPWV in all subgroups.

Conclusions

We found positive association of VAI with baPWV and high arterial stiffness in normal-weight adults with hypertension. The establishment of this association could help the arterial stiffness risk stratification in normal-weight hypertensive populations, who are frequently overlooked in preventing cardiovascular disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12986-021-00617-5.

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.

The Accuracy of Visceral Adiposity Index for the Screening of Metabolic Syndrome: A Systematic Review and Meta-Analysis

BACKGROUND AND AIMS

Visceral adiposity index (VAI) is a novel marker of fat distribution and function which incorporates both anthropometric and laboratory measures. Recently, several studies have suggested VAI as a screening tool for metabolic syndrome (MetS). Here, we aimed to consolidate the results of these studies by performing a systematic review and meta-analysis.

METHODS AND RESULTS

We searched PubMed and EMBASE online databases for eligible studies that investigated the association of VAI and MetS. After reviewing 294 records, we included 33 eligible papers with a sum of 20516 MetS and 53242 healthy participants. The risk of bias in the included studies was assessed, and the relevant data was extracted. All included studies reported a significant association between VAI and MetS screening, but were highly heterogeneous in their reported effects. We pooled the diagnostic test accuracy metrics of VAI for MetS screening and showed that it has a moderate-to-high accuracy with an area under the summary receiver operating characteristics curve of 0.847, a pooled sensitivity of 78%, and a pooled specificity of 79%. Besides, we pooled the difference in means of VAI between patients with MetS and healthy controls, revealing that VAI was 2.15 units higher in MetS patients.

CONCLUSIONS

VAI is an accurate, low-cost, and widely available screening marker for MetS. However, further studies are needed to evaluate its applicability in clinical practice, determine an optimal cut-off, and identify populations that would benefit the most from it.

Visceral Adiposity Index is a predictor of incident colorectal cancer: a population-based longitudinal study

Objective

The Visceral Adiposity Index (VAI) is a marker of visceral fat accumulation and dysfunction. We aimed to investigate the association between VAI and incident colorectal cancer (CRC).

Design

In this historical cohort study of 27 921 (16 434 men and 11 487 women) participants, we divided the participants into tertiles according to VAI. We calculated VAI: men, VAI = (waist circumference (WC)/(39.68+1.88 × body mass index (BMI))) × (triglycerides (TG)/1.03) × (1.31/high-density lipoprotein cholesterol (HDL)); women, VAI = (WC/(36.58+1.89 × BMI)) × (TG/0.81) × (1.52/HDL). We performed Cox proportional hazard models, adjusting for sex, age, smoking, alcohol consumption, exercise, haemoglobin A1c and systolic blood pressure.

Results

During the median 4.4-year follow-up, 116 participants developed CRC. Compared with the lowest tertile, the HRs of incident CRC in the middle and the highest tertiles were 1.30 (95% CI 0.76 to 2.28, p=0.338) and 2.41 (1.50 to 4.02, p<0.001) in univariate analysis. Moreover, the HRs of incident CRC in the middle and the highest tertiles were 1.27 (0.73 to 2.23, p=0.396) and 1.98 (1.15 to 3.39, p=0.013) after adjusting for covariates.

Conclusions

VAI can be a predictor of incident CRC. For early detection, we should encourage people with high VAI to undergo screening for CRC.

Lipid indices as simple and clinically useful surrogate markers for insulin resistance in the U.S. population

This study aimed to compare the accuracy of novel lipid indices, including the visceral adiposity index (VAI), lipid accumulation product (LAP), triglycerides and glucose (TyG) index, TyG-body mass index (TyG-BMI), and TyG-waist circumference (TyG-WC), in identifying insulin resistance and establish valid cutoff values. This cross-sectional study used the data of 11,378 adults, derived from the United States National Health and Nutrition Examination Survey (1999-2016). Insulin resistance was defined as a homeostasis model assessment-insulin resistance value above the 75th percentile for each sex and race/ethnicities. The area under the curves (AUCs) were as follows: VAI, 0.735; LAP, 0.796; TyG index, 0.723; TyG-BMI, 0.823, and; TyG-WC, 0.822. The AUCs for TyG-BMI and TyG-WC were significantly higher than those for VAI, LAP, and TyG index (vs. TyG-BMI, p < 0.001; vs. TyG-WC, p < 0.001). The cutoff values were as follows: VAI: men 1.65, women 1.65; LAP: men 42.5, women 42.5; TyG index: men 4.665, women 4.575; TyG-BMI: men 135.5, women 135.5; and TyG-WC: men 461.5, women 440.5. Given that lipid indices can be easily calculated with routine laboratory tests, these values may be useful markers for insulin resistance risk assessments in clinical settings.

Evaluation of Novel Obesity and Lipid-Related Indices as Indicators for the Diagnosis of Metabolic Syndrome and Premetabolic Syndrome in Chinese Women with Polycystic Ovary Syndrome

OBJECTIVES

According to the International Diabetes Federation (IDF) criteria, previous studies in Chinese women with polycystic ovary syndrome (PCOS) reported a low prevalence of metabolic syndrome (MS); however, the same population predisposed to developing pre-MS. Early identification and treatment of individuals with MS and pre-MS are imperative to prevent their adverse consequences. Moreover, fasting plasma glucose (FPG) was not accurate in detecting pathoglycemia in women with PCOS as they have shown characteristically postprandial abnormalities in the carbohydrate metabolism. Therefore, we aimed to compare the discriminative performance of various indices for identifying MS and pre-MS/MS (pre-MS and MS) using the updated Chinese Diabetes Society (uCDS) criteria in Chinese women with PCOS.

METHODS

1083 Chinese women with PCOS were included in this study. We measured and evaluated 8 indices in all individuals. Based on the uCDS criteria for MS, patients who had no less than two components of MS but did not meet the criteria for the diagnosis of MS were considered as having pre-MS. Receiver operating characteristic (ROC) curves and the area under ROC curves (AUCs) levels were used to assess the accuracy of each index in detecting MS and pre-MS/MS.

RESULTS

Among the 8 indices assessed, the lipid accumulation product (LAP) provided the highest AUCs for detecting MS and pre-MS/MS, followed by CVAI, WTI, VAI, TyG, TG/HDL, WC, and BMI. The optimal cutoff points determined for LAP were 45.13 (sensitivity 88.0%, specificity 88.4%, and Youden index 0.764) for MS and 28.01 (sensitivity 87.5%, specificity 80.7%, and Youden index 0.681) for pre-MS/MS, respectively.

CONCLUSIONS

uCDS criteria are reasonably more suitable for detecting MS and pre-MS in Chinese women with PCOS. Based on this criterion, LAP is the best index for the diagnosis of MS and pre-MS/MS in Chinese women with PCOS, out of the 8 obesity and lipid-related indices assessed.

Visceral adiposity index is a better predictor of type 2 diabetes than body mass index in Qatari population

The prevalence of type 2 diabetes (T2D) has increased recently in Qatar. Body mass index (BMI) is a predictor of T2D in many populations. However, BMI is based on height and weight measurements and not on body adiposity. Therefore, the utility of BMI for predicting the risk of T2D has been questioned. Visceral adiposity appears to be a better predictor of T2D.This study aimed to assess the relative effectiveness of visceral adiposity index (VAI) and body adiposity index (BAI), in comparison with BMI, for T2D among Qatari adults.A random sample of 1103 adult Qatari nationals and long term residents over 20 years old were included in this study. This data were obtained from the Qatar Biobank (QBB). We performed a multivariate logistic regression to examine the association between VAI, BAI, BMI, and T2D, and computed z-scores for VAI, BAI and BMI.VAI z-scores showed the strongest association with the risk of T2D (OR, 1.44; 95% CI: 1.24-1.68) compared with the z-scores for BAI (OR, 1.15; 95% CI: 0.93-1.43) and BMI (OR, 1.33; 95% CI: 1.11-1.59). ROC curve analysis showed that VAI was a stronger predictor than BAI and BMI (P < .0001). Subgroup analysis indicated that the association was stronger between VAI and T2D in Qatari women than in men.VAI was a stronger and an independent predictor of T2D compared to BAI and BMI among the Qatari adult population. Therefore, VAI could be a useful tool for predicting the risk of T2D among Qatari adults.

The Role of Visceral Adiposity Index as Predictor of Metabolic Syndrome in Obese and Nonobese Women with Polycystic Ovary Syndrome

Background: To evaluate anthropometric-metabolic biomarkers as predictors of metabolic syndrome (MS) in women with polycystic ovary syndrome (PCOS) with and without obesity. Methods: This was an observational cross-sectional study. Patients were classified as nonobese-PCOS (body mass index, BMI <30 kg/m², n = 385), and obese-PCOS (BMI ≥30 kg/m², n = 261). The anthropometric parameters waist circumference, waist/hip ratio, lean body mass, fat body mass, visceral adiposity index (VAI), lipid accumulating product, and biomarkers of glucose and lipid metabolisms were compared between groups. Binominal logistic regression analyses were performed to identify predictors of MS. Results: Obesity was diagnosed in 40% of all PCOS women (P < 0.001). Blood pressure and anthropometric abnormalities were significantly more frequent in obese-PCOS women (P < 0.001, for all comparisons). Glucose metabolism markers were higher in obese-PCOS compared with nonobese-PCOS (P < 0.001, for all comparisons). High-density lipoprotein cholesterol was lower in obese group than in nonobese group (1.26 mM vs. 1.08 mM, P < 0.001). MS was found in 23 of 385 (6%) nonobese-PCOS and in 116 of 261 (44.4%) obese-PCOS (P < 0.001). VAI was the best predictor of MS in both nonobese-PCOS (OR = 4.1, 95% CI 1.5-11.1) and obese-PCOS (OR = 12.9, 95% CI 5.7-29.0). Conclusions: MS is more prevalent in PCOS women with obesity. VAI was the strongest predictor of MS in both obese and nonobese PCOS women, and can be applied in clinical practice for early detection of risk for MS and precocious intervention in women with PCOS, particularly in obese women.

The visceral adiposity index is a predictor of incident nonalcoholic fatty liver disease: A population-based longitudinal study

BACKGROUND AND AIMS

Visceral adiposity index (VAI), calculated with body mass index, high-density lipoprotein cholesterol, triglyceride and waist circumference, has been proposed as a marker of visceral fat accumulation and dysfunction.

METHODS

The impact of VAI on incident nonalcoholic fatty liver disease (NAFLD) in a historical cohort study of 8399 (3773 men and 4626 women) participants. NAFLD was defined as having fatty liver diagnosed by abdominal ultrasonography. We divided the participants into two groups according to sex and into quartiles according to VAI (Q1-4). We calculated VAI using the formulas. Men: VAI = [waist circumference (WC)/39.68 + (1.88 × body mass index [BMI])] × [triglycerides (TG)/1.03] × [1.31/high-density lipoprotein cholesterol (HDL)]; women: VAI = [WC/36.58 + (1.89 × BMI)] × (TG/0.81) × (1.52/HDL). We performed Cox proportional hazard models, adjusting for age, alanine aminotransferase, fasting plasma glucose, systolic blood pressure, alcohol consumption, smoking status and exercise.

RESULTS

During the median 4.5-year follow-up for men and 4.9-year follow-up for women, 1078 participants (737 men and 341 women) developed NAFLD. The 4000 days cumulative incidence rate of NAFLD for men and women were 7.5% and 2.2% in Q1, 14.5% and 4.0% in Q2, 22.3% and 6.7% in Q3 and 33.8% and 16.7% in Q4. The hazard ratios of incident NAFLD in Q4 (VAI: men, > 1.13; women, > 0.83) were 3.69 (95% confidence interval 2.84-4.86, P < 0.001) in men and 4.93 (3.28-7.73, P < 0.001) in women, compared to Q1 (VAI: men, < 0.44; women, < 0.36).

CONCLUSIONS

The visceral adiposity index can be a predictor of incident NAFLD.

The Effectiveness of New Adiposity Indices on Plasma Lipid Profile in Patients with Multiple Sclerosis: A Cross-Sectional Study with A Body Shape Index, Body Roundness Index, and Visceral Adiposity Index

OBJECTIVE

This study aimed to determine the effectiveness of three different indices used to identify the effect of visceral adiposity on lipid profile markers in patients with multiple sclerosis.

METHODS

The study consisted of a total of 152 patients with relapsing-remitting multiple sclerosis who were aged 18 years and older. High-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), and triglyceride (TG) were accessed from the patient system. Patients' height, body weight, waist circumference, and hip circumference measurements were also obtained. The effects of three different adiposity indices, including A Body Shape Index (ABSI), the Body Roundness Index (BRI), and the Visceral Adiposity Index (VAI), on plasma lipid profile in multiple sclerosis patients were evaluated. The data were analyzed using the R software and SPSS 21 statistical software package.

RESULTS

HDL-c was impacted by ABSI and VAI in males and only VAI in females (p < 0.05). An increase of 0.01 units of ABSI in males led to an increase of 5.88 mg/dL in plasma HDL-c level. In male patients with multiple sclerosis, LDL-c was positively affected by BRI and VAI changes (p < 0.05). One unit increase in BRI in males increased LDL-c level by 5.56 mg/dL, whereas 1 unit increase in VAI increased LDL-c level by 3.52 mg/dL (p < 0.05).

CONCLUSION

This study indicated that these three different indices employed to evaluate adiposity were associated with plasma lipid profile. The effect of VAI on plasma lipids is higher than that of the other indices. In patients with multiple sclerosis, the use of these practical and non-invasive indices will be useful in assessing plasma lipid profile.

The Visceral Adipose Index in Relation to Incidence of Hypertension in Chinese Adults: China Health and Nutrition Survey (CHNS)

Hypertension is the most crucial single contributor to global burden of disease and mortality, while weight loss as a non-pharmacological strategy is recommended to reduce blood pressure. This study aims to examine the association between visceral adipose index (VAI) and hypertension in Chinese adults. Data were collected from the China Health and Nutrition Survey (CHNS), consisting of 8374 apparently healthy participants aged ≥18 years in the 2009 CHNS for cross-sectional analysis, and 4275 participants at entry from 2009 to 2011 for cohort analysis. Height, weight, waist circumference, blood pressure (BP), and blood lipid were measured. Information of population characteristics, smoking status, alcohol consumption, physical activity, and diet were determined by validated questionnaire. Higher VAI scores were significantly associated with higher BP levels and higher risk of hypertension after adjustment with potential confounders (all p-trend < 0.001). The adjusted hazard ratio of hypertension was 1.526 (95%CI: 1.194, 1.952; p-trend < 0.01) for participants in the highest quartile of VAI scores when compared with those in the lowest quartile after adjustment for age, physical activity, antihypertensive medication, total energy intake, salt intake, and other major lifestyle factors. VAI scores were significantly, longitudinally associated with hypertension development among apparently healthy Chinese adults.

Ramadan fasting improves liver function and total cholesterol in patients with nonalcoholic fatty liver disease

Abstract. Background: Nonalcoholic fatty liver disease (NAFLD) is a serious global health problem, thus the prevention and management of the disease is necessary. This study aimed to determine the effects of Ramadan Fasting (RF) on liver function, Visceral Adiposity Index (VAI) and Atherogenic Index of Plasma (AIP) in these patients.

Methods: Eighty-three NAFLD patients (57 males and 26 females) were enrolled in the study, 42 patients who practiced RF, between Jun 18 through July 17, 2015 and 41 patients in non-fasting groups. Anthropometric parameters and Ultrasound grading were measured before and after Ramadan. The biochemical parameters including lipid profiles (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), liver enzymes (Aspartate aminotransferase, SGOT and Alanine aminotransferase, SGPT) were evaluated before and after Ramadan. AIP and VAI were calculated based on formula.

Results: The mean decreases in anthropometric indices were significantly different between groups. Similarly, the mean decrease in the total cholesterol values in the fasting group was remarkably greater than in the control group (p = 0.02). The values of AIP and VAI decreased at the end of the study in both group and the mean of changes showed no differences between groups (p = 0.79 and p = 0.65 for AIP and VAI, respectively). The changes in the concentrations of liver enzymes, as well as the severity of hepatic steatosis, showed remarkable differences between groups (p = 0.03, p = 0.05, and p = 0.02 for SGOT and SGPT, and Liver steatosis, respectively).

Conclusion: RF improved liver steatosis in NAFLD patients and might be useful in the management of NAFLD.

Comparison of Novel Metabolic Indices in Estimation of Chronic Kidney Diseases in a Southern Chinese Population

BACKGROUND

To determine the optimal cut-off values and evaluate the associations of product of triacylglycerol and glucose (TyG), lipid accumulation product (LAPI), visceral adiposity index (VAI) with chronic kidney diseases (CKD) stratified by sex.

METHODS

From January to April 2018, our team had conducted a large-scale cross-sectional survey that contained 2720 individuals on the southern coast of China. Logistic regression analysis and receiver operating characteristic (ROC) analyses were used to evaluate the optimal cut-off and value of TyG, LAPI, VAI for predicting CKD.

RESULTS

A multivariate logistic regression analysis found that the TyG had the better value of prediction for the presence of CKD for the highest quartile vs the lowest quartile in both males (OR: 3.65; 95% CI, 2.04-6.52; p<0.001) and females (OR: 3.50; 95% CI, 2.20-5.56; p<0.001), followed by LAPI and VAI, when further adjusted for cofounder factors, LAPI and VAI both lost their independence, and only TyG remains its significant association with CKD in both males (OR: 2.81; 95% CI, 1.25-6.30; p<0.001) and females (OR: 3.22; 95% CI, 1.56-6.61; p<0.001). ROC curve showed that TyG had the highest AUC for predicting CKD in males (AUC: 0.618). TyG (AUC: 0.670) and LAPI (AUC: 0.670) both had the highest AUC in females. United predicted models which contain TyG were conducted for predicting CKD in males (AUC: 758) and females (AUC: 0.773) and results indicated that multivariate analysis of TyG and other traditional factors can impressively improve the accuracy of predictive probability for CKD.

CONCLUSION

TyG is a priority to the other two novel indices and may become valuable makers and have strong predictive power for predicting CKD, especially in females.

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

AIMS

Visceral adiposity and albuminuria are commonly observed in patients with type 2 diabetes mellitus (T2DM). Recently, the visceral adipose index (VAI) was found to be an indicator of visceral fat accumulation. However, the relationship between the VAI and urinary albumin has not been investigated in T2DM patients, and whether the predictive value of the VAI is superior to that of the triglyceride/high-density lipoprotein cholesterol (TG/HDL-c) ratio remains unknown.

MATERIALS AND METHODS

Three hundred and forty one newly diagnosed T2DM patients were enrolled. The anthropometric parameters, blood pressure, glucose, lipid profiles, urinary albumin, and other biochemical indices were examined. Linear and logistic regression models were developed to assess the association between the VAI and urinary albumin.

RESULTS

The prevalence of microalbuminuria was 41.3% (n = 141) and increased with increasing levels of VAI. An age-adjusted partial correlation analysis showed that the VAI and TG/HDL-c ratio were significantly associated with the waist-to-hip ratio, heart rate, total cholesterol, low-density lipoprotein cholesterol, and uric acid. In the stepwise linear regression analysis, the VAI (β = .21, .009) and TG/HDL-c (β = .25, .002) were significant determinants of urinary albumin. Moreover, in the multiple logistic regression model, the odds ratio (OR) of microalbuminuria per one SD increase in the VAI was 1.94 (95% CI, 1.11-3.38), and a similar result was observed with a higher TG/HDL-c ratio (OR = 2.03, 95% CI, 1.13-3.65).

CONCLUSION

We are the first to show a clear association between the VAI and urinary albumin in Chinese type 2 diabetic patients. Additionally, the VAI and TG/HDL-c ratio had similar predictive power regarding albuminuria risk. The VAI could be a rapid and reliable tool for assessing early-stage renal damage in newly diagnosed T2DM patients.

Potential Role of New Anthropometric Parameters in Childhood Obesity with or Without Metabolic Syndrome

BACKGROUND

Obese children and adolescents are more prone to have metabolic syndrome (MS).MS is a cluster of cardiovascular risk factors associated with insulin resistance. Body round index [BRI], visceral adiposity index [VAI] and a body shape index [ABSI] are among the new obesity anthropometric parameters.

AIM

To evaluate the new markers for obesity in children and their possible association with other laboratory and clinical variables of MS.

METHODS

Eighty nine obese children and 40 controls aged 10-18 years were recruited. Full history taking, thorough clinical examination, anthropometric and biochemical features were performed in the studied groups. Subcutaneous fat thickness (SFT) and visceral fat thickness (VFT) were estimated by ultrasonography.

RESULTS

Obese children, exhibited significantly higher values in all anthropometric measurements (P < 0.001). Diastolic and systolic blood pressure were significantly higher (P < 0.001) in the obese group. ABSI, BRI and VAI have been found to be significantly higher in obese subjects (P < 0.001), with no significant gender difference. BMI, WHtR, WC/HR, SBP, DBP, subcutaneous fat thickness and visceral fat thickness, Liver Span, ABSI, BRI, VAI and HOMA_IR were significantly higher among children with MS than those without MS. Positive significant correlations of VAI with BMI, WC/Ht, WC/Hip, SBP, DBP, SFT, VFT, Liver size and HOMA-IR (r = 0.384, 0.239, 0.268, 0.329, 0.516, 0.320, 0.254, 0.251, and 0.278 respectively) are shown. The area under the ROC curve (AUC) of BMI, VAI, ABSI, BRI for predicting MS was 0.802 (0.701-0.902), 0.737 (0.33-0.841), 0.737 (0.620-0.855), 0.816 (0.698-0.934).

CONCLUSION

We suggest using the VAI and WHtR indexes, as they are better predictor of MS.

Visceral adipose accumulation increased the risk of hyperuricemia among middle-aged and elderly adults: a population-based study

BACKGROUND

The role of body fat distribution in uric acid metabolism is still ambiguity. We aimed to investigate the independent contribution of visceral adipose measured by visceral adiposity index and lipid accumulation product and liver fat assessed by fatty liver index to the risk of hyperuricemia.

METHODS

We conducted a cross-sectional study involving 1284 participants aged ≥ 40 years old recruited from communities in Zhonglou district, Changzhou. Each participant completed a standard questionnaire, and provided blood samples for biochemical measurements. Visceral adiposity index, fatty liver index and lipid accumulation product were calculated by simple anthropometric and functional parameters. Hyperuricemia was defined as serum uric acid ≥ 420 μmol/l for males and ≥ 360 μmol/l for females.

RESULTS

The prevalence of hyperuricemia was 15.9% and gradually increased across tertiles of adiposity-based indices. The visceral adipose-based measurements (visceral adiposity index, fatty liver index, lipid accumulation product) had better power to discriminate hyperuricemia than body mass index (BMI), waist circumference and neck circumference, and visceral adiposity index exhibited the highest power, with the area under the receiver operating characteristics curve (AUROC) of 0.662 (0.636-0.688). Multivariate logistic regression found 1.49-fold, 2.21-fold and 2.12-fold increased risk of hyperuricemia with 1-unit increment of visceral adiposity index, fatty liver index, and lipid accumulation product, respectively. Compared to tertile 1, the odds ratios of hyperuricemia for the second tertile and the third tertile of visceral adiposity index were 1.57 (1.00-2.50) and 3.11 (1.96-4.94), those of fatty liver index were 1.64 (1.05-2.68) and 3.58 (1.94-6.01), and those of lipid accumulation product were 1.93 (1.19-3.15) and 3.53 (2.05-6.09), respectively. However, no significant associations of BMI, waist circumference and neck circumference with hyperuricemia were observed.

CONCLUSIONS

Visceral adipose accumulation increased the risk of hyperuricemia, independently of BMI, waist circumference and neck circumference, among middle-aged and elderly Chinese adults.

Comparisons of Visceral Adiposity Index, Body Shape Index, Body Mass Index and Waist Circumference and Their Associations with Diabetes Mellitus in Adults

The associations between visceral adiposity index (VAI), body shape index and diabetes in adults were inconsistent. We assessed the predictive capacity of VAI and body shape index for diabetes by comparing them with body mass index (BMI) and waist circumference (WC). We used the data of 5838 Chinese men and women aged ≥18 years from the 2009 China Health and Nutrition Survey. Multivariate logistic regression analysis was performed to examine the independent associations between Chinese VAI (CVAI) or body shape index and diabetes. The predictive power of the two indices was assessed using the receiver-operating characteristic (ROC) curve analysis, and compared with those of BMI and WC. Both CVAI and body shape index were positively associated with diabetes. The odds ratios for diabetes were 4.9 (2.9–8.1) and 1.8 (1.2–2.8) in men, and 14.2 (5.3–38.2) and 2.0 (1.3–3.1) in women for the highest quartile of CVAI and body shape index, respectively. The area under the ROC (AUC) and Youden index for CVAI was the highest among all four obesity indicators, whereas BMI and WC are better indicators for diabetes screening. Higher CVAI and body shape index scores are independently associated with diabetes risk. CVAI has a higher overall diabetes diagnostic ability than BMI, WC and body shape index in Chinese adults. BMI and WC, however, are more appealing as screening indicators considering their easy use.

Visceral adiposity index (VAI), lipid accumulation product (LAP), and product of triglycerides and glucose (TyG) to discriminate prediabetes and diabetes

The present study evaluated the ability of the visceral adiposity index (VAI), the lipid accumulation product (LAP), and product of triglycerides and glucose (TyG), three novel, insulin resistance-related markers, to discriminate prediabetes/diabetes in the general German population. Altogether 2,045 Germans (31-72 years, 53.3% women) without known diabetes and a history of Myocardial Infarction (MI)/stroke from the Cooperative Health Research in the Region of Augsburg (KORA) F4 Study were eligible. The discriminatory accuracy of the markers for oral glucose tolerance test (OGTT)-defined prediabetes/diabetes according to the American Diabetes Association (ADA) criteria was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). The Youden Index (YI) was used to determine optimal cut-off values, and a non-parametric ROC regression was used to examine whether the discriminatory accuracy varied by sex and age. 365 men (38.2%) and 257 women (23.6%) were newly diagnosed with prediabetes/diabetes. AUCs for TyG, LAP and VAI were 0.762 (95% CI 0.740-0.784), 0.743 (95% CI 0.720-0.765), and 0.687 (95% CI 0.662-0.712), respectively. The optimal cut-off values for the LAP and TyG were 56.70 and 8.75 in men, and 30.40 and 8.53 in women. In conclusion, TyG and LAP provide good discrimination of persons with prediabetes/diabetes.

Triglycerides and waist to height ratio are more accurate than visceral adiposity and body adiposity index to predict impaired fasting glucose

AIMS

To evaluate the clinical accuracy of novel indices visceral adiposity index (VAI) and body adiposity index (BAI) to identify patients with impaired fasting glucose (IFG) and compare with its individual components and other obesity indicators.

METHODS

A cross-sectional study was conducted in Mexican population. Body mass index (BMI), waist circumference, hip circumference, triglycerides (TG), High density lipoprotein cholesterol (HDL-C), VAI, BAI, waist to hip ratio (WHR) and waist to height ratio (WHtR) were determined. We plotted a receiver operating characteristic curves to assess the abilities to discriminate subjects with IFG from those with normal glucose tolerance (NGT) of the measurements. A binary logistic regression analysis was performed to determine the strength of association with IFG.

RESULTS

A total of 280 individuals were included, from which 144 (51.3%) have IFG; the mean age was 47.14 years and 164 (55.5%) were females. Compared with NGT subjects, the participants with IFG had significantly higher levels of BMI, WHtR, VAI, BAI and TG. The measurements with highest area under the curve were TG, (0.631, 95% confidence interval [CI] 0.566-0.697) VAI (0.628, 95% CI 0.563-0.693) and WHtR (0.622, 95% CI 0.557-0.688) and in the adjusted binary logistic regression model, were found to be independently associated with IFG, Odds Ratio of 2.665, (95% CI 1.567-4.533) 2.567 (95% CI 1.527-4.317) and 2.171 (95% CI 1.102-4.276) respectively.

CONCLUSIONS

Our data provide evidence that TG, VAI and WHtR could be considered potential tools for the risk assessment of type 2 diabetes mellitus (T2DM) in this population.

The Relationship Between Visceral Adiposity Index and Epicardial Adipose Tissue in Patients with Type 2 Diabetes Mellitus

Introduction and aim Cardiovascular diseases remain the most common cause of morbidity and mortality in patients with diabetes. Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Increased visceral adiposity is associated with proinflammatory activity, impaired insulin sensitivity, increased risk of atherosclerosis and high mortality. In the present study we aimed to investigate the relationship between EAT and visceral adiposity index (VAI) in patients with diabetes.

Methods This was a cross-sectional study involving 128 patients with type 2 diabetes mellitus (73 females, 55 males; mean age, 54.09+±+9.17 years) and 32 control subjects (23 females, 9 males; mean age, 50.09+±+7.81 years). EAT was measured by using a trans-thoracic echocardiograph. Parameters such as waist circumference (WC), body mass index (BMI), triglyceride and high density lipoprotein (HDL) cholesterol were used to calculate VAI.

Result EAT and VAI measurements were significantly higher in patients with diabetes when compared to control subjects. In the bivariate correlation analysis, VAI was positively correlated with uric acid level (r=0.214, p=0.015), white blood cell count (r= 0.262, p=0.003), platelet count (r=0.223, p=0.011) and total cholesterol levels (r= 0.363, p<0.001). Also, VAI was found to be the independent predictor of EAT.

Conclusion Simple calculation of VAI was found to be associated with increased EAT in patients with type 2 diabetes.

Visceral Adiposity Index: Simple Tool for Assessing Cardiometabolic Risk in Women with Polycystic Ovary Syndrome

AIM

To study visceral adiposity index (VAI) and its association with cardiometabolic risk in different phenotypes of polycystic ovary syndrome (PCOS).

MATERIALS AND METHODS

It is a case-control cross-sectional study where 100 reproductive age (18-35 years) women with PCOS were classified in different phenotypes as per Rotterdam criteria and compared with age and Body mass index (BMI) matched 50 eumenorrheic and nonhirsute women. Various anthropometric, clinical, biochemical, and hormonal parameters were measured in both women with PCOS and controls. VAI was calculated using waist circumference (WC), BMI, serum triglyceride, and High density lipoprotein (HDL) cholesterol levels in all the subjects and compared between cases and controls. Subsequently, women with PCOS were assessed for cardiometabolic risk according to androgen excess society statement 2010 as "at risk" and "at high risk." Finally, risk was correlated with VAI for all the phenotypes of PCOS.

RESULTS

Mean VAI was significantly higher (P < 0.001) in cases than controls (2.07 vs. 1.27). Mean VAI in phenotype A (O+P+HA), B (O+HA), C (P+HA), and D (O+P) was 2.46, 2.48, 1.47, and 1.70, respectively. A total of 56% of women with PCOS were at risk and 12% at high risk for cardiometabolic disease. Metabolic syndrome was prevalent in 11% of cases and 1% had type 2 diabetes mellitus. Phenotypically, 88% of women with PCOS with phenotype A (O+P+HA), 67% of B (O+HA), 67% of C (P+HA), and 55% of D (O+P) were at increased risk. VAI was found to be positively correlated with WC (r, 0.550), waist to hip ratio (r, 0.295), Homeostasis model assessment of insulin resistance (HOMA IR) (r, 0.455), and cardiometabolic risk (r, 0.399). Also, it was the best factor associated with cardiometabolic risk (area under curve, 0.793).

CONCLUSION

This study concluded that visceral adiposity index can be used as simple and effective tool for assessing the cardiometabolic risk in women with PCOS as higher VAI values were observed in those cases who were at high risk for developing cardiometabolic disorder in future.

The impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical, hormonal and metabolic parameters in lean women with polycystic ovary syndrome

This study was performed to assess the impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical, hormonal, and metabolic parameters in lean women with PCOS. Retrospective analysis of 120 consecutive lean PCOS subjects was performed. Subjects were divided into two groups according to HOMA-IR, as IR + and IR-. A HOMA-IR value above 2.5 was used to indicate IR. Clinical, hormonal and metabolic parameters were compared between the two groups. Correlations between LAP and VAI and clinical, hormonal, metabolic features in women PCOS were analyzed. One hundred twenty lean PCOS subjects were enrolled, of which 39 were insulin resistant. Comparison of group means showed significantly higher values for TG levels, FAI, FGS, TG/HDL-c, TyG, LAP, and VAI indexes and lower values for glucose/insulin ratio and QUICKI in the IR + group. LAP and VAI were both found to be positively correlated with each other and with WC, FAI, FGS, TG, TC levels, lipid ratios, TyG index, and HOMA-IR and negatively correlated with Glucose/Insulin ratio, QUICKI, and HDL-c in lean women with PCOS. LAP and VAI may be promising in early identification of IR and cardiometabolic risk and may be useful for the assessment of hyperandrogenism in lean women with PCOS.

Visceral Adiposity Index as an Independent Marker of Subclinical Atherosclerosis in Individuals Prone to Diabetes Mellitus

Aims: The visceral adiposity index (VAI) has been proposed as an estimate of visceral adipose tissue (VAT) mass and as an indicator of VAT dysfunction. Both parameters are associated with cardiometabolic risk, including insulin resistance. In this study, we investigated whether VAI is associated with subclinical atherosclerosis in subjects who were free of cardiovascular disease but were at risk of developing diabetes mellitus.

Methods: A total of 731 adults with a median age of 47 years old without diabetes mellitus were included in this cross-sectional study. The anthropometric data, blood pressure, and lipid profiles of 398 women and 333 men were measured. All subjects underwent an oral glucose tolerance test, and carotid intima–media thickness (cIMT) was evaluated by ultrasound. Insulin resistance was estimated using the homeostatic model assessment of insulin resistance (HOMA-IR).

Results: VAI and HOMA-IR (β_st = 0.44, p < 0.0001), VAI and cIMT (β_st = 0.17, p < 0.0001), and HOMA-IR and cIMT (β_st = 0.09, p = 0.0127) were correlated with each other. After adjusting for cofounding variables, VAI is still correlated with HOMA-IR (β_st = 0.42, p < 0.0001). Furthermore, VAI (β_st = 0.07, p = 0.0392) but not HOMA-IR (β_st = 0.03, p = 0.37) was correlated with cIMT independently of other established cardiovascular risk factors.

Conclusion: The calculation of VAI may provide a better estimation of subclinical atherosclerosis than the calculation of HOMA-IR.