Association between visceral adipose index and risk of hypertension in a middle-aged and elderly Chinese population

Association of visceral adiposity index with hypertension (NHANES 2003-2018)

Objectives

This study focused on the association between visceral adiposity index (VAI) and the prevalence of hypertension in a nationally representative population of American adults.

Methods

The study obtained data from the National Health and Nutrition Examination Survey (NHANES) database from 2003-2018 for a large-scale study. This study incorporated participants ≥18 years of age. Multivariate logistic regression modelling and smoothed curve fitting were applied to investigate the existence of a correlation between VAI and hypertension prevalence. Subgroups were analyzed to confirm the stationarity of the association between VAI and hypertension prevalence. In addition, an interaction test was conducted in this study.

Results

In completely adapted sequential models, the risk of hypertension prevalence in the overall population increased 0.17-fold with each 1-unit increase in VAI [odds ratio (OR) = 1.17; 95% confidence interval (CI) 1.12-1.22]. In the wholly adapted categorical model, there was a 0.95-fold increased risk of hypertension in the population of VAI quartile 4 (Q4) vs. VAI quartile 1 (Q1) (OR = 1.95; 95% CI 1.62-2.35). These results indicate that VAI was strongly related to the occurrence of hypertension, and smoothed curve-fitting analysis showed nonlinearity. Adjustment for covariates revealed no apparent interactions in the subgroup analyses, and results were stable across subgroups.

Conclusion

This cross-sectional study suggests a nonlinear and positive correlation between elevated VAI and the adult risk of developing hypertension in U.S. adults.

Association of serum creatinine to cystatin C to waist circumference ratios and hypertension: evidence from China health and retirement longitudinal study

Background

The objective of this study was to explore the association between the ratio of serum creatinine to cystatin C to waist circumference (CCR/WC) and hypertension.

Methods

The study utilized data extracted from the China Health and Retirement Longitudinal Study. In the cross-sectional analysis, logistic regression analyses were employed to examine the association between the CCR/WC ratio and hypertension. By utilizing restricted cubic splines, potential non-linear associations between the CCR/WC ratio and hypertension were explored. In the longitudinal analysis, the association between CCR/WC quartiles (Q1-Q4) and the risk of new-onset hypertension was evaluated by Cox proportional-hazards models.

Results

In total, 7,253 participants were enrolled. The study unveiled an inverse association with hypertension, demonstrating an odds ratio (OR) of 0.29 (95% confidence interval [CI]: 0.23-0.37, P < 0.001). Among males, an OR of 0.38 (95% CI: 0.25-0.58, P < 0.001) was observed, while among females, an OR of 0.41 (95% CI: 0.28-0.60, P < 0.001) was noted. There was an absence of a nonlinear association between the CCR/WC ratio and hypertension. Cox regression analysis unveiled a reduced risk of hypertension in Q3 (Hazard ratios [HR]: 0.69, 95% CI: 0.58-0.82, P < 0.001) and Q4: (HR: 0.70, 95% CI: 0.59-0.83, P < 0.001) in compared to the Q1 of the CCR/WC ratio, and sex-specific analysis yielded consistent results.

Conclusion

This study emphasizes the potential association between an elevated CCR/WC ratio and a reduced risk of hypertension.

Cardiometabolic risk assessment: A school-based study in Brazilian adolescent

BACKGROUND AND AIMS

Recently, new indices combining routine and low-cost anthropometric and biochemical measurements have emerged. Among them, the visceral adiposity index (VAI) and lipid accumulation product (LAP) are being investigated for the prediction of altered blood pressure (BP) and insulin resistance (IR). Therefore, this study aimed to evaluate whether visceral adiposity index (VAI) and height-corrected lipid accumulation product (HLAP) are predictors of cardiometabolic risk in Brazilian adolescents.

METHODS AND RESULTS

Data were obtained from the Cardiovascular Risk in Adolescents (ERICA) study, a cross-sectional, national, multicenter, school-based survey conducted between 2013 and 2014 in Brazil. The sample consisted of 37,815 adolescents aged 12-17 years of both genders attending the last 3 years of elementary or secondary school from public and private schools located in 273 municipalities with more than 100,000 inhabitants. A Poisson regression was performed to verify associations between VAI and HLAP indices and the presence of altered BP and IR according to sex. In addition, receiver operating characteristic curve (ROC) analysis was applied to compare the predictive ability and determine the cut-off points of the VAI and HLAP indices in identifying cardiometabolic risk obtained by altered BP and IR. The prevalences of altered BP and IR were 24.49 % (95 % confidence interval [CI]: 23.14-25.87) and 24.22 % (95 % CI: 22.70-25.80), respectively.

CONCLUSIONS

The VAI and HLAP indices are good predictors of cardiometabolic risk in Brazilian adolescents. HLAP showed better performance in identifying insulin resistance in males.

The relationship between anthropometric indices and the presence of hypertension in an Iranian population sample using data mining algorithms

Hypertension (HTN) is a common chronic condition associated with increased morbidity and mortality. Anthropometric indices of adiposity are known to be associated with a risk of HTN. The aim of this study was to identify the anthropometric indices that best associate with HTN in an Iranian population. 9704 individuals aged 35-65 years were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study. Demographic and anthropometric data of all participants were recorded. HTN was defined as a systolic blood pressure (SBP) ≥ 140 mmHg, and/ or a diastolic blood pressure (DBP) ≥ 90 mmHg on two subsequent measurements, or being treated with oral drug therapy for BP. Data mining methods including Logistic Regression (LR), Decision Tree (DT), and Bootstrap Forest (BF) were applied. Of 9704 participants, 3070 had HTN, and 6634 were normotensive. LR showed that body roundness index (BRI), body mass index (BMI) and visceral adiposity index (VAI) were significantly associated with HTN in both genders (P < 0.0001). BRI showed the greatest association with HTN (OR = 1.276, 95%CI = (1.224, 1.330)). For BMI we had OR = 1.063, 95%CI = (1.047, 1.080), for VAI we had OR = 1.029, 95%CI = (1.020, 1.038). An age < 47 years and BRI < 4.04 was associated with a 90% probability of being normotensive. The BF indicated that age, sex and BRI had the most important role in HTN. In summary, among anthropometric indices the most powerful indicator for discriminating hypertensive from normotensive patients was BRI.

Development and validation of machine learning models for nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) had become the most prevalent liver disease worldwide. Early diagnosis could effectively reduce NAFLD-related morbidity and mortality. This study aimed to combine the risk factors to develop and validate a novel model for predicting NAFLD.

METHODS

We enrolled 578 participants completing abdominal ultrasound into the training set. The least absolute shrinkage and selection operator (LASSO) regression combined with random forest (RF) was conducted to screen significant predictors for NAFLD risk. Five machine learning models including logistic regression (LR), RF, extreme gradient boosting (XGBoost), gradient boosting machine (GBM), and support vector machine (SVM) were developed. To further improve model performance, we conducted hyperparameter tuning with train function in Python package 'sklearn'. We included 131 participants completing magnetic resonance imaging into the testing set for external validation.

RESULTS

There were 329 participants with NAFLD and 249 without in the training set, while 96 with NAFLD and 35 without were in the testing set. Visceral adiposity index, abdominal circumference, body mass index, alanine aminotransferase (ALT), ALT/AST (aspartate aminotransferase), age, high-density lipoprotein cholesterol (HDL-C) and elevated triglyceride (TG) were important predictors for NAFLD risk. The area under curve (AUC) of LR, RF, XGBoost, GBM, SVM were 0.915 [95% confidence interval (CI): 0.886-0.937], 0.907 (95% CI: 0.856-0.938), 0.928 (95% CI: 0.873-0.944), 0.924 (95% CI: 0.875-0.939), and 0.900 (95% CI: 0.883-0.913), respectively. XGBoost model presented the best predictive performance, and its AUC was enhanced to 0.938 (95% CI: 0.870-0.950) with further parameter tuning.

CONCLUSIONS

This study developed and validated five novel machine learning models for NAFLD prediction, among which XGBoost presented the best performance and was considered a reliable reference for early identification of high-risk patients with NAFLD in clinical practice.

Association between visceral adiposity index and heart failure: A cross-sectional study

BACKGROUND

Obesity is an important risk factor for heart failure (HF).

HYPOTHESIS

Visceral adiposity index (VAI) is a simple metric for assessing obesity; however, the association between VAI and risk for HF has not been studied.

METHODS

A cross-sectional study involving 28 764 participants ≥18 years of age from the National Health and Nutrition Examination Survey (NHANES), 2009-2018, in the United States was performed. VAI was calculated using body mass index (BMI), waist circumference (WC), triglycerides (TG), and high-density lipoprotein cholesterol. VAI was analyzed as a continuous and categorical variable to examine its association with HF. Subgroup analysis was also performed.

RESULTS

The highest VAI (fourth quartile [Q4]) was found among males, BMI, systolic and diastolic blood pressure, WC, hypertension, diabetes, liver disease, coronary heart disease, smoking, total cholesterol, and TG. More participants in Q4 took β-receptor blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor-neprilysin inhibitor, calcium channel blockers, and antidiabetic and antihyperlipidemic medications. Participants with HF exhibited greater VAI. A per-unit increase in VAI resulted in a 4% increased risk for HF (odds ratio [OR] 1.04 [95% confidence interval (CI) 1.02-1.05]). After multivariable adjustment, compared with the lowest quartile, the OR for Q3 was 1.55 (95% CI 1.24-1.94). Subgroup analysis revealed no significant interactions between VAI and specific subgroups.

CONCLUSION

VAI was independently associated with the risk for HF. As a noninvasive index of visceral adiposity, VAI could be used for a "one shot" assessment of HF risk and may serve as a novel marker.

The elevated visceral adiposity index increases the risk of hyperuricemia in Chinese hypertensive patients: A cross-sectional study

Background

Uncertainty still remained about the relationship between visceral adiposity index (VAI) and hyperuricemia. The aim of this study was to investigate whether VAI was an independent risk factor for hyperuricemia in hypertensive Chinese patients.

Methods

A cross-sectional study including 13176 hypertensive participants (6478 males) recruited from Wuyuan County, Jiangxi province, was conducted. All patients received anthropometric measurements, completed questionnaires and provided blood samples for biochemical testing. VAI was calculated by waist circumference, BMI, triglyceride and high-density lipoprotein cholesterol. Hyperuricemia was defined as serum uric acid ≥ 7 mg/dL in men and ≥ 6 mg/dL in women.

Results

Overall, the average level of uric acid was 7.8 ± 2.0 mg/dL in males and 6.34 ± 1.78 in females and prevalence of hyperuricemia was 61.4% and 51.30%, respectively. In multivariate logistic regression analysis, the risk of hyperuricemia increased 1.77 times and 1.88 times with the increase of ln VAI in males (OR:1.77, 95% CI: 1.62, 1.94) and females (OR:1.88, 95% CI: 1.73, 2.04). For males, compared to quartile 1, the risk of hyperuricemia in the second, third and the forth quartile of visceral adiposity index were 1.34 (95% CI: 1.14, 1.57),1.82(95% CI: 1.54, 2.14) and 2.97 (95% CI: 2.48, 3.57). For females, compared to quartile 1, the risk of hyperuricemia in the second, third and the forth quartile of visceral adiposity index were 1.48 (95% CI: 1.28, 1.72), 1.99 (95% CI: 1.71, 2.32) and 2.92 (95% CI: 2.50, 3.42).

Conclusions

This study found that VAI was an independent risk factor for hyperuricemia among hypertensive patients, which may provide some strategies for reducing the level of uric acid.

Comparison of 10 obesity-related indices for predicting hypertension based on ROC analysis in Chinese adults

Objective

To compare the predictive performance of the percentage body fat (PBF), body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), waist-height ratio (WHtR), a body shape index (ABSI), body roundness index (BRI), abdominal volume index (AVI), and conicity index (CI) for identifying hypertension.

Methods

A cross-sectional study was conducted among 2,801 adults (1,499 men and 1,302 women) aged 18 to 81 in Ningbo, China. The receiver operator characteristic (ROC) analysis and multiple non-parametric Z tests were used to compare the areas under the curve (AUC). The maximum Youden's indices were used to determine the optimal cut-off points of 10 obesity-related indices (ORI) for hypertension risk.

Results

The AUC of all the indices were statistically significant (P < 0.05). The AUC of all the indices in men and women were 0.67-0.73 and 0.72-0.79, respectively. Further non-parametric Z tests showed that WHR had the highest AUC values in both men [0.73 (95% CI: 0.70, 0.76)] and women (0.79 (95% CI: 0.75, 0.83)], and several central ORI (men: WHR, WC, BRI, AVI, and CI, 0.71-0.73; women: WC, WHR, and AVI, 0.77-0.79) were higher than general ORI (PBF and BMI, 0.68 in men; 0.72-0.75 in women), with adjusted P < 0.05. The optimal cut-off points for identifying hypertension in men and women were as follows: PBF (23.55%, 32.55%), BMI (25.72 kg/m², 23.46 kg/m²), HC (97.59 cm, 94.82 cm), WC (90.26 cm, 82.78 cm), WHR (0.91, 0.88), WHtR (0.51, 0.55), ABSI (0.08 m^7/6/kg^2/3, 0.08 m^7/6/kg^2/3), BRI (4.05, 4.32), AVI (16.31 cm², 13.83 cm²), and CI (1.23 m^2/3/kg^1/2, 1.27 m^2/3/kg^1/2). Multivariate logistic regression models showed that all indices were statistically significant (P < 0.05) with the adjusted ORs (per 1-SD increase) at 1.39-2.06 and ORs (over the optimal cut-off points) at 1.80-2.64.

Conclusions

All 10 ORI (PBF, BMI, HC, WC, WHR, WHtR, ABSI, BRI, AVI, and CI) can effectively predict hypertension, among which WHR should be recommended as the best predictor. Central ORI (WHR, WC, and AVI) had a better predictive performance than general ORIs (PBF and BMI) when predicting the risk of hypertension.

Relationship Between Skeletal Muscle Mass to Visceral Fat Area Ratio and Cardiovascular Risk in Type 2 Diabetes

PURPOSE

Either visceral fat or muscle mass is identified to be correlated with cardiometabolic diseases, especially in type 2 diabetes (T2DM). But, the synergistical effect of visceral fat along with skeletal muscle on the risk of cardiovascular diseases (CVD) in T2DM still remains controversial. Thus, we investigated the relationship between skeletal muscle mass to visceral fat area ratio (SVR) and 10-yr CVD risk scores.

PATIENTS AND METHODS

A total of 291 T2DM patients aged 40-80 years were enrolled in the current study. SVR was evaluated based on bioelectrical impedance measurements. Both Framingham risk score system and China-PAR risk model were applied to estimate future 10-yr CVD risk in T2DM population.

RESULTS

The 10-yr CVD risk scores increased with the decreased SVR tertiles in T2DM (All P<0.001). SVR value was obviously lower in the high-risk group than that of low- or moderate-risk group (All P<0.05). However, no significant differences were observed in BMI among different CVD risk groups. Besides, SVR was correlated with Framingham risk score (r=-0.408; P<0.001) and China-PAR risk score (r=-0.336; P<0.001). HOMA-IR, triglycerides and blood pressure were also inversely related to SVR (All P<0.05). Furthermore, SVR value was independently correlated with both Framingham 10-yr CVD risk score (β=-0.074, P=0.047) and China-PAR risk score (β=-0.100, P=0.004) after adjustment for confounding factors, including age, gender, BMI, FPG, HbA1c, diabetes duration, albumin, creatinine, uric acid, smoking, blood pressure and blood lipid. The linear regression analysis was also conducted for men and women, respectively, indicating that the negative relationship between SVR and 10-yr CVD risk was observed in men but not in women.

CONCLUSION

T2DM populations who have lower SVR value are more likely to increase CVD risk. SVR levels show marked and inverse correlation with estimated 10-yr CVD risk in T2DM, indicating that SVR could be a valuable parameter to assess the risk of CVD events in clinical practice, especially in men.