Association of Visceral Adiposity Surrogates with Impaired Fasting Glucose in Nonobese Individuals

Wakabayashi & Daimon cardiometabolic index as an indicator to assess risk in adults. A systematic review

OBJECTIVE

To analyze the Wakabayashi & Daimon (2015) equation, as a predictive indicator of cardiometabolic diseases and its comparison with other indices.

DESIGN

A systematic review was carried out between January and March 2023, according to the PRISMA statement.

DATA SOURCE

Scopus, Web of Science, and PubMed databases were reviewed using "cardiometabolic index" (CMI) as the search term.

STUDY SELECTION

The following inclusion criteria were determined: studies in adults with cardiometabolic diseases using the Wakabayashi & Daimon (2015) CMI formula in different populations; studies that validate or compare the equation or that demonstrate the effects of the intervention.

DATA EXTRACTION

Of the 11 selected articles, the characteristics of the population, type of study, indicators for the validation of the CMI, the reported statistics and the conclusions that were recorded in a comparative table were obtained.

RESULTS AND CONCLUSIONS

Odds ratio, hazard ratio, sensitivity, and specificity were used to assess associations, risk, effectiveness, and validity of the tests, indicating favorable relationships between the factors analyzed and the results obtained. Validation and probabilistic analysis of the CMI were performed against diverse diseases such as obesity [Man >60y=AUC=0.90 (0.75-1.00) (p=0.01), Se=100, Sp=81.8, YI=0.82 and OR 4.66 and Women >60y=AUC=0.95 (0.88-1.00), p=0.001, Se=90.0, Sp=100, YI=0.90 and OR=36.27]; cardiovascular diseases [AUC=0.617, Se=0.675, Sp=0.509; HR=1.48 (1.33, 1.65), p=<0.001], among others. In conclusion CMI is a new utility index that broadly identifies the presence of risk that leads to cardiometabolic diseases in adults.

Characteristics of Different Obesity Metabolic Indexes and their Correlation with Insulin Resistance in Patients with Polycystic Ovary Syndrome

This study is aimed to investigate the characteristics of different obesity metabolic indexes [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), cardiometabolic index (CMI), body roundness index (BRI), visceral adiposity index (VAI), and lipid aggregation products (LAP)] and their correlation with insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS). The study was conducted on 140 subjects with PCOS and 133 control subjects aged 18-44 years. According to insulin resistance index (HOMA-IR) ≥ 2.69 and HOMA-IR < 2.69, PCOS group members were divided into insulin resistance group and non-insulin resistance group. Anthropometric and serological characteristics of the population with PCOS focused on calculating different obesity metabolic indexes and HOMA-IR. BMI, WC, WHR, WHtR, CMI, BRI, VAI, and LAP were significantly higher in PCOS patients than in the control group, and the differences were all statistically significant (P < 0.05); In the insulin resistance group of PCOS patients, BMI, WC, WHR, WHtR, CMI, BRI, VAI, and LAP were significantly higher than in the non-insulin resistance group (P < 0.05). In PCOS patients, BMI (r = 0.658, P < 0.001), WC (r = 0.0.662, P < 0.001), WHR (r = 0.377, P < 0.001), WHtR (r = 0.660, P < 0.001), CMI (r = 0.698, P < 0.001), BRI (r = 0.757, P < 0.001), VAI (r = 0.640, P < 0.001), and LAP (r = 0.767, P < 0.001) were positively correlated with IR. Obesity metabolic indexes associated with PCOS were elevated in the PCOS group compared to the control group, and in the PCOS insulin-resistant group compared to the non-insulin resistant group. Novel obesity metabolic indexes, especially CMI, BRI and LAP, might be more appropriate for evaluating the risk of concurrent IR in PCOS.

Lipid accumulation product is closely associated with hypertension and prehypertension in prediabetic population in China: results from the REACTION study

Prediabetes with hypertension or prehypertension increases the risk of cardiovascular events. Lipid accumulation product (LAP) is a powerful marker of visceral obesity. The current study aimed to explore the relationship between LAP and hypertension and prehypertension among prediabetic individuals. A total of 12,388 prediabetic participants from the REACTION study were recruited. LAP was calculated from waist circumference and fasting triglyceride levels. Multiple logistic regression models were conducted to assess the relationship between LAP and hypertension and prehypertension. Multiple logistic regression analysis showed that elevated LAP was associated with hypertension (Q2: odds ratio (OR): 1.263, P < 0.001; Q3: OR: 1.613, P < 0.001; Q4: OR: 1.754, P < 0.001) and prehypertension (Q2: OR: 1.255, P = 0.005; Q3: OR: 1.340, P = 0.002; Q4: OR: 1.765, P < 0.001). The results of the stratified analysis showed that prediabetic people with higher LAP levels and characterized by overweight, normal weight and a high waist-to-hip ratio (WHR) were more likely to have hypertension, and prediabetic people with higher LAP levels and characterized by overweight, normal weight, a high WHR, age <65, and low and high levels of physical activity were more likely to have prehypertension. In conclusion, visceral obesity assessed by LAP is significantly associated with hypertension and prehypertension in the Chinese prediabetic population.

Visceral adiposity index is positively associated with fasting plasma glucose: a cross-sectional study from National Health and Nutrition Examination Survey 2017-2020

BACKGROUND

Visceral adiposity index (VAI) has been recognized as a reliable indicator for visceral adiposity. However, it remains largely unexplored on its association with fasting plasma glucose (FPG). The current study aims to explore the association between VAI and FPG using a representative dataset.

METHODS

A cross-sectional study was carried out based on the dataset from National Health and Nutrition Examination Survey (NHANES) 2017-2020. Univariate and Multiple linear regression analysis were performed to explore the relationship between VAI and FPG. Generalized additive model (GAM) and smooth curve fitting analysis were performed to explore the nonlinear relationship between VAI and FPG. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of VAI for FPG elevation.

RESULTS

A total of 4437 participants with complete data were finally included in the research. Individuals were divided into 4 quartiles according to the calculated VAI value: Q1 (VAI<0.69), Q2 (0.69 ≤ VAI < 1.18), Q3 (1.18 ≤ VAI < 2.02) and Q4 (VAI ≥ 2.02). FPG significantly increased with the increasing VAI quartile. Multiple linear regression analysis showed VAI was independently positively associated with FPG after adjusting confounding factors. As a continuous variable, an increase of one unit in VAI was correlated with 0.52 mmol/L (95% CI: 0.41-0.63, p < 0.0001) higher FPG level. As a categorical variable, 4th VAI quartile group was related to 0.71 mmol/L (95% CI: 0.47-0.95, p < 0.001) higher FPG level compared with 1st VAI group. GAM and smooth curve fitting analysis identified the non-linear relationship between VAI and FPG, and 4.02 was identified as the inflection point using two-piecewise linear regression. The positive association between VAI and FPG existed when VAI was lower (β = 0.73, p < 0.0001) and higher than 4.02 (β = 0.23, p = 0.0063). ROC analysis indicated VAI has a good predictive value for FPG elevation (AUC = 0.7169, 95% CI: 0.6948-0.7389), and the best threshold of VAI was 1.4315.

CONCLUSION

VAI was an independently risk indicator for FPG, and VAI was nonlinearly positively associated with FPG. VAI had a good predictive value for elevated FPG. VAI might become a useful indicator for risk assessment and treatment of hyperglycemia in clinical practice.

Comparative analysis of the association between traditional and lipid-related obesity indicators and isolated systolic hypertension : Association of obesity indicators with ISH

Background

Obesity is a well-known modified risk factor for isolated systolic hypertension (ISH), but evidence is lacking regarding whether the combination of anthropometric and lipid indicators could strengthen their correlation with ISH. Therefore, we compared the association of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), visceral adiposity index (VAI), lipid accumulation product index (LAP), and cardiometabolic index (CMI) with ISH.

Methods

A total of 106,248 adults who received routine health screening and did not have diastolic blood pressure ≥ 90 mmHg were recruited in this cross-sectional study. The associations between these indicators and ISH were evaluated using multivariate regression.

Results

Each standard deviation (SD) increase in traditional obesity indicators (especially WHR and WHtR) had significantly higher multivariate-adjusted odds ratios (ORs) than each SD increase in lipid-related obesity indicators. In addition, multivariate-adjusted ORs for ISH in the third (vs. the first) tertile of traditional obesity indicators were also significantly higher than those of lipid-related indicators. Moreover, traditional obesity indicators exhibited a higher area under the ROC curve for discriminating ISH than lipid-related obesity indicators.

Conclusions

Traditional obesity indicators were more strongly associated with ISH than lipid-related obesity indicators among Chinese adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02564-2.

Metabolic Obesity in People with Normal Body Weight (MONW)-Review of Diagnostic Criteria

Disorders of metabolic obesity with normal body weight (MONW) are widely recognized risk factors for the development of cardiovascular diseases and type 2 diabetes. Despite this, MONW is not diagnosed in clinical practice. There is no consensus on the definition of MONW, and measuring the degree of insulin resistance or obesity among apparently healthy, non-obese patients is not widely applicable. The awareness of the relationship between metabolic disorders such as MONW and a higher risk of mortality from cardiovascular causes and other related diseases prompts the need for action to be taken aimed at creating appropriate diagnostic models that will allow for the effective detection of those with metabolic abnormalities among people with normal body weight. Such actions are decisive in the prevention and treatment of diseases. Therefore, the purpose of this article is to review the MONW diagnostic criteria used over the years.

Association between cardiometabolic index and stroke: A population-based cross-sectional study

BACKGROUND

Cardiometabolic index (CMI) is associated with several risk factors for stroke; however, few studies have assessed the role of CMI in stroke risk.

OBJECTIVE

This study aimed to assess the association between CMI and stroke in a population-based cross-sectional study.

METHODS

This study included 4445 general residents aged ≥40 years selected by multistage stratified random cluster sampling. CMI was calculated as the product of the ratio of waist circumference to height (WHtR) and the ratio of triglyceride levels to high-density lipoprotein cholesterol levels (TG/HDL-C). Participants were categorized according to CMI quartiles: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4). Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to assess the association between CMI and stroke.

RESULTS

A total of 4052 participants were included in the study, with an overall stroke prevalence of 7.2%. The prevalence of stroke increased with CMI quartiles, ranging from 4.4% to 9.2% (p for trend <0.001). Compared with Q1, stroke risk for Q2, Q3, and Q4 were 1.550-, 1.693-, and 1.704- fold, respectively. The area under the ROC curve (AUC) [95% CI] was (0.574 [0.558-0.589]) for CMI, 0.627 [0.612-0.642]) (p=0.0024) for WHtR, 0.556 [0.540-0.571]) (p<0.0001) for TG/HDL-C. CMI was inferior to WHtR, but CMI had marginal advantage over TG/HDL-C in terms of its stroke discrimination ability.

CONCLUSION

Although there was a strong and independent association between CMI and stroke in the general population, CMI had limited discriminating ability for stroke. Thus, new parameters should be developed.

Association between visceral adiposity index and risk of prediabetes: A meta-analysis of observational studies

Background and Objective

Epidemiological studies suggested that the association between the visceral adiposity index (VAI) and the risk of prediabetes is inconsistent. Whether VAI is a useful predictor of prediabetes remains unclear. Up until April 2021, there had been no systematic review on this topic. In this meta‐analysis, the available observational epidemiological evidence was synthesized to identify the association between VAI and prediabetes risk.

Methods

PubMed, EMBASE, and Cochrane databases in any language were searched systematically from the earliest available online indexing year to April 2021 for relevant observational studies published on the association between VAI and the risk of prediabetes. A random effects model was used to combine quantitatively the odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Ten relevant studies (2 cohort study, 2 case‐control studies, and 6 cross‐sectional studies) involving 112,603 participants were identified. Compared with the highest VAI, the lowest level of VAI was associated with an increased risk of prediabetes. The pooled OR of VAI for prediabetes was 1.68 (95% CI: 1.44–1.96), with significant heterogeneity across the included studies (P = 0.000, I² = 91.4%). Exclusion of any single study did not materially alter the combined risk estimate.

Conclusions

Integrated epidemiological evidence supports the hypothesis that VAI is a lipid combined anthropometric index and may be a risk factor for prediabetes. VAI may be related to a high risk of prediabetes. However, it should be noted that the included studies have a publication bias and there was significant heterogeneity between our pooled estimate.

Cardiometabolic index: a new tool for screening the metabolically obese normal weight phenotype

PURPOSE

People with the metabolically obese normal weight (MONW) phenotype are considered as an extremely high-risk group for unfavorable health consequences, but they are frequently undetected due to deceptive body mass index (BMI) and complex assessment. This study aimed to explore the clinical usefulness of cardiometabolic index (CMI) in identifying MONW individuals.

METHODS

This cross-sectional study involved a total of 47,683 normal-weight subjects aged ≥ 18 years. Participants underwent anthropometrics, routine biochemical tests, and questionnaires for a full evaluation of the metabolic profile. The odds ratio (OR) of CMI and MONW phenotype was determined by the Logistic regression models and the diagnostic accuracy of CMI was evaluated by the receiver operating characteristic (ROC) curve analysis.

RESULTS

The prevalence of MONW phenotype was 11.0%. After multivariate adjustment, the ORs for MONW in the highest compared with the lowest quartile of CMI was 71.20 (95% CI 55.19-91.86), and 1-SD increment of CMI brought a 54% additional risk. In ROC analysis, compared with BMI and waist circumference, CMI showed superior performance for identifying MONW individuals with an AUC of 0.853 (95% CI 0.847-0.860) in men and 0.912 (95% CI 0.906-0.918) in women, respectively. Moreover, CMI exhibited the highest diagnostic accuracy in younger age groups (aged 18-34 for men; aged 18-34 and 35-44 for women), in which AUCs surpassed 0.9 in both sexes.

CONCLUSIONS

CMI could be served as a valuable indicator to identify MONW phenotype of Chinese adults, particularly for young people.

The Association of Body Composition Parameters and Simultaneously Measured Inter-Arm Systolic Blood Pressure Differences

Background and Objectives: An inter-arm systolic blood pressure difference (IASBPD) is defined as a blood pressure (BP) disparity of ≥10 mmHg between arms. IASBPDs are associated with an increased risk of cardiovascular disease (CVD). Similarly, visceral fat accumulation (VFA) is clinically important because it is associated with higher cardiovascular disease risk. Accordingly, this study compared the body composition parameters of IASBPD individuals with individuals who did not express an IASBPD. Materials and Methods: The analysis included 104 patients. The blood pressures of all participants were measured simultaneously in both arms using automated oscillometric devices. Then patients were divided into two groups according to their IASBPD status: Group 1 (IASBPD- (<10 mmHg)); Group 2 (IASPPD+ (≥10 mmHg)). Body composition parameters were measured using bioelectrical impedance analysis. Results: In 42 (40%) patients, the simultaneously measured IASBPD was equal to or higher than 10 mmHg. The right brachial SBP was higher in 63% of patients. There were no differences between the groups in terms of demographic and clinical characteristics. Regarding the two groups' body composition parameter differences, VFA was significantly higher in group 2 (p = 0.014). Conclusions: The IASBPD is known to be associated with an increased risk of cardiovascular events. Although the body mass indexes (BMIs) of the two groups were similar, VFA levels in those with a greater than 10 mmHg IASBPD were found to be significantly higher. This finding may explain the increased cardiovascular risk in this group.