Lipid accumulation product and incident cardiovascular events in a normal weight population: Tehran Lipid and Glucose Study

A prospective cohort study on the effect of lipid accumulation product index on the incidence of cardiovascular diseases

BACKGROUND

Cardiovascular disease (CVD) is a chronic disease with a serious prognosis, and obesity is a risk factor for CVD. Lipid accumulation product index (LAP) is a new indicator of obesity, waist circumference, and triglycerides were included in the formula, but its association with CVD is inconsistent. Therefore, this study researched the effect of LAP levels on CVD.

METHODS

This prospective cohort study was based on the Kailuan cohort. A total of 95,981 participants who completed the first physical examination in 2006 and had no history of CVD or LAP absence were included. The participants were divided into four groups according to the LAP quartile (Q1 - Q4). Up until December 31, 2022, incidence density was calculated for each group. The hazard ratio (HR) and 95% confidence interval (CI) of CVD in each group were calculated by the Cox proportional hazards model.

RESULTS

During a median follow-up period of 15.95 years, 9925 incident CVD events occurred (2123 myocardial infarction and 8096 stroke). There were differences in potential confounders among the four groups (P < 0.001). The incidence density and 95% CI of CVD in Q1-Q4 groups were 4.76(4.54, 5.00), 6 0.50(6.24, 6.77), 8.13(7.84, 8.44) and 9.34(9.02, 9.67), respectively. There were significant differences in the survival curves among the four groups by log-rank test (P < 0.001). After adjusting for potential confounders, Cox proportional hazards model results showed that compared with the Q1 group, the HR and 95% CI of CVD in the Q2, Q3, and Q4 groups were1.15(1.08, 1.23), 1.29(1.21, 1.38) and 1.39(1.30, 1.49), respectively. The HR and 95%CI of myocardial infarction were 1.28(1.10, 1.49), 1.71(1.47, 1.98) and 1.92(1.64, 2.23), respectively. The HR and 95%CI of stroke were 1.11 (1.03, 1.19), 1.20 (1.12, 1.29) and 1.28 (1.19, 1.38), respectively. After subgroup analysis by gender, there was no significant interaction (P = 0.169), and the relationship between LAP and CVD in different genders was consistent with the main results. After subgroup analysis by age, there was a significant interaction (P = 0.007), and the association between LAP and CVD in different age groups was consistent with the main results. After subgroup analysis by BMI, there was no significant interaction (P = 0.506), and the association between LAP and CVD in different BMI groups was consistent with the main results. The results remained robust after sensitivity analyses. For each unit increase in ln(LAP), the HR and 95%CI of CVD were 4.07 (3.92, 4.23).

CONCLUSION

This study demonstrated that the risk of CVD increased with the increase of LAP level. The risk of CVD in group Q2 - Q4 was 1.15, 1.29, and 1.39 times higher than that in group Q1, respectively.

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR2000029767.

The effect of cumulative lipid accumulation product and related long-term change on incident stroke: The Kailuan Study

BACKGROUND AND AIMS

A single measurement lipid accumulation product (LAP) level has been shown to increase cardiovascular disease, but cumulative LAP on stroke effects is uncertain.

METHODS AND RESULTS

This study included 43,089 participants, free of any cardiovascular diseases at baseline, from the Kailuan Study. The cumulative LAP was determined by multiplying the average LAP index and the time interval between two consecutive examinations, resulting in their categorization into four quartile groups. The higher LAP exposure was defined as participants with LAP values exceeding 90% of this population during each health survey. The association between cumulative LAP and stroke was assessed using multivariable Cox proportional hazard models. During a median follow-up period of 11.0 (10.6-11.3) years, 2461 participants developed stroke (of which 2220 were ischemic stroke, 320 were hemorrhagic stroke, and 79 were concurrent). After adjusting for potential confounders, the risk of stroke gradually increased in Groups Q2 to Q4 compared to Q1, with hazard ratios (HRs) ranging from 1.19 (95% CI: 1.05-1.36) to 1.50 (95% CI: 1.30-1.70). Specifically, the risk of ischemic stroke showed an increase from 1.21 (1.06-1.39) to 1.56 (1.36-1.79), while no statistically significant effect was observed for hemorrhagic stroke. The longer duration of higher LAP index exposure was also associated with increased stroke risk. Similar results were obtained in the stratification and sensitivity analyses.

CONCLUSION

Cumulative LAP was positively and significantly associated with incident stroke, especially ischemic stroke, and a longer duration of exposure to higher LAP may increase the risk of stroke.

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.

Evaluation of the novel three lipid indices for predicting five- and ten-year incidence of cardiovascular disease: findings from Kerman coronary artery disease risk factors study (KERCADRS)

BACKGROUND

Data are limited on the relationship between cardiovascular disease (CVD) and the combinational indices of lipid accumulation product (LAP), triglyceride-glucose index (TyG), and visceral adiposity index (VAI). The association of these novel indices with the 5- and 10-year incidence of CVD was assessed.

METHOD

A total of 1888 and 1450 healthy adults aged between 15 and 75 years (out of the 5895 participants of the KERCADR study, 2012) were followed for five and ten years, respectively. Baseline LAP, TyG, and VAI were calculated and logistic regression models were used to assess their relationship with the incidence of CVD in the two follow-up periods. Also, the predictive performance of these three indices was analyzed using the area under ROC curve (AUC) for the development of CVD compared with traditional single indices.

RESULTS

In the 5- and 10-year follow-ups, 399 and 476 CVD cases (21.1% and 32.8%) were documented, respectively. For the 5-year CVD risk, the adjusted odds ratio (AOR, 95% CI) was LAP (2.24 [1.44, 3.50]), VAI (1.58 [1.08, 2.33]), and TyG (1.57 [1.02, 2.42]). For the 10-year CVD risk, the AOR was LAP (1.61 [1.04, 2.49]), TyG (1.57 [1.02, 2.41]), and VAI (1.41 [0.96, 2.09]). In both periods and sexes, LAP had the best performance with the highest AUCs (0.644 and 0.651) compared to the other two indices and compared to the traditional single indices (e.g., BMI, LDL, etc.).

CONCLUSION

Overall LAP, TyG, and VAI were better CVD risk predictors compared to the traditional single risk factors, with LAP showing the strongest predictive power for the incidence of CVD.

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.

Association between visceral obesity and 10-year risk of first atherosclerotic cardiovascular diseases events among American adults: National Health and Nutrition Examination Survey

Background

In the United States, the relationship between visceral obesity and the risk of developing atherosclerosis cardiovascular disease (ASCVD) for the first time in 10 years is unclear.

Methods

Data for this cross-sectional study came from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020. We collected variable information related to 10-year ASCVD risk and visceral obesity reliable indicators [Visceral obesity index (VAI) and Lipid accumulation product (LAP)]. And we used multiple logistic regression to analyze the correlation of visceral obesity indicators (VAI and LAP) with 10-year ASCVD risk. In addition, we assessed the linear relationship between VAI or LAP and 10-year ASCVD risk by smoothing curve fitting. Finally, we conducted subgroup analysis and sensitivity analysis after excluding participants with extreme VAI and LAP values to ensure that we obtained accurate and reliable results.

Results

Our study included a total of 1,547 participants (mean age: 56.5 ± 10.1, 60% of males). The results of the multiple logistic regression showed that compared with participants with the lowest VAI in the 1st Quartile (≤0.79), the adjusted OR values for VAI and elevated 10-year ASCVD risk in Q3 (1.30-2.14), and Q4 (≥2.15) were 2.58 (95% CI: 1.24-5.36, P = 0.011), 15.14 (95% CI: 6.93-33.05, P < 0.001), respectively. Compared with participants with the lowest LAP in the 1st Quartile (≤28.29), the adjusted OR values for VAI and elevated 10-year ASCVD risk in Q3 (46.52-77.00), and Q4 (≥77.01) were 4.63 (95% CI: 2.18-9.82, P < 0.001), 16.94 (95% CI: 6.74-42.57, P < 0.001), respectively. Stratified analysis showed that the association between VAI or LAP and the first ASCVD event was more pronounced in males.

Conclusion

Higher VAI or LAP scores are significantly associated with elevated 10-year ASCVD risk in adults aged 40 to 79 in the USA, which suggested that monitoring visceral obesity is crucial to reduce the risk of a first ASCVD event.

Interrelation between the lipid accumulation product index and diabetic kidney disease in patients with type 2 diabetes mellitus

Objective

The purpose of this study was to determine the relation between the lipid accumulation product index (LAPI) and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM).

Methods

Herein, 931 patients were enrolled and their data were collected. Then the interrelation between LAPI and DKD was assessed using multivariate logistic regression analyses (LRAs) and by a restricted cubic spline (RCS).

Results

In total, 931 participants (352 females and 579 males) aged 55 years on average were included in the study. After adjusting for several confounders, the odds ratio for DKD was increased evidently in the third LAPI tertile compared with that in the first LAPI tertile. In addition, the RCS revealed a positive interrelation between LAPI and DKD. In the subgroup analyses, age, sex, hyperlipidemia, hypertension, and HbA1c did not significantly interact with LAPI.

Conclusions

LAPI was higher in the DKD group than in the no-DKD group, and LAPI is positively linked with DKD, which may have potential value to diagnose DKD in clinical practice.

Higher visceral adiposity index and lipid accumulation product in relation to increased risk of atherosclerotic burden in community-dwelling older adults

BACKGROUND AND AIMS

Visceral adiposity index (VAI) and lipid accumulation product (LAP), as anthropometric indices, have been applied to predict the risk of cardiovascular diseases (CVD). However, few studies investigated the correlation between these two indicators and cardio-cerebro-vascular atherosclerosis in community populations. Our study was to explore the association of VAI and LAP with coronary, intracranial and extracranial atherosclerosis in a community-based asymptomatic middle-aged and older population.

METHODS

Participants without a history of CVD in the study of PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) were included. The sex-special indicators of VAI and LAP were calculated and stratified by the tertiles. The presence of plaque and coronary segmental stenosis score (SSS) were assessed by coronary computed tomography (CTA), as well as intracranial and extracranial atherosclerotic burden were evaluated by high-resolution magnetic resonance imaging (HR-MRI), respectively. Binary or ordinal logistic regression was conducted to assess the association between each of the indexes and the presence and burden of atherosclerosis.

RESULTS

A total of 2875 subjects were included in the final analysis. The mean age was 60.9 ± 6.6 years and 1329 (46.2 %) participants were males. Compared with the first tertile of VAI, the higher tertile was associated with the presence of plaques (T3 vs T1, OR, 1.49, 95%CI, 1.12-1.98, for males; OR, 1.64, 95%CI, 1.24-2.17, for females) and atherosclerotic burden (T3 vs T1, adjusted cOR, 1.63, 95%CI, 1.24-2.14, for males; adjusted cOR, 1.70, 95%CI, 1.29-2.24, for females) in major coronary arteries. A similar association was found for LAP. VAI level has presented an association with the extracranial atherosclerotic plaques (T3 vs T1, OR, 1.34, 95%CI, 1.02-1.77) and burden (T3 vs T1, adjusted cOR 1.32, 95 % CI 1.00-1.73) only in females. Whereas, for intracranial atherosclerosis, the results failed to show any statistically significant association.

CONCLUSIONS

Among community-dwelling asymptomatic older adults, VAI and LAP were associated with the presence and burden of coronary atherosclerotic plaques, while VAI presented a weaker significant association with extracranial atherosclerosis in females.

Association of low-carbohydrate diet score and carbohydrate quality with visceral adiposity and lipid accumulation product

The present study examined the association between low-carbohydrate diet (LCD) score, glycemic index (GI), and glycemic load (GL) with visceral fat level (VFL) and lipid accumulation product (LAP). This cross-sectional study was conducted on 270 adults (118 men and 152 women) aged between 18-45 living in Tehran, Iran, between February 2017 and December 2018. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Body composition were also assessed. We used analyses of covariance and binary logistic regression to explore associations after controlling for age, energy intake (model 1), education, smoking status, physical activity, occupation, marriage and metabolic diseases. There were no significant differences between tertiles of GI, GL and LCD for means of anthropometric measures, LAP and VFL index in men, while women in the highest tertile of GI and GL had significantly higher mean LAP in the crude model (P = 0·02) and model 1(P = 0·04), which disappeared after controlling for other confounders (P = 0·12). Moreover, the OR and CIs for having high LAP and VFL was not associated with dietary GI, GL and LCD in crude and adjusted models. However, chance of high VFL reduced by 65% and 57% among women with high adherence to LCD score (OR = 0·35, 95% CI = 0·16-0·78, P = 0·01) and model 1 (OR = 0·43, 95% CI = 0·18-1, P = 0·05), respectively. However, this significant association disappeared after controlling for other confounders (P = 0·07). Overall, we found carbohydrate quality and LCD score are not associated with LAP and VFL index. However, gender-specific relationship should not be neglect and warrants further investigation.

Association between abdominal obesity indices and risk of cardiovascular events in Chinese populations with type 2 diabetes: a prospective cohort study

BACKGROUND

Waist circumference (WC), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) are considered surrogate indicators of abdominal fat deposition, but the longitudinal association of these indices with cardiovascular (CV) events in adults with type 2 diabetes (T2D) remains unclear. Our study aimed to examine the associations between abdominal obesity indices and incident CV events among people with T2D and to compare their predictive performance in risk assessment.

METHODS

The present study included 2328 individuals with T2D from the Xinjiang Multi-Ethnic Cohort. Multivariable Cox regression analyses were applied to assess the associations between abdominal obesity indices and CV events. Harrell's concordance statistic (C-statistic), net reclassification improvement (NRI) index, and integrated discrimination improvement (IDI) index were utilized to evaluate the predictive performance of each abdominal obesity index.

RESULTS

At a median follow-up period of 59 months, 289 participants experienced CV events. After multivariable adjustment, each 1-SD increase in WC, VAI, LAP, and CVAI was associated with a higher risk of CV events in people with T2D, with adjusted hazard ratios (HRs) being 1.57 [95% CI (confidence interval): 1.39-1.78], 1.11 (95% CI 1.06-1.16), 1.46 (95% CI 1.36-1.57), and 1.78 (95% CI 1.57-2.01), respectively. In subgroup analyses, these positive associations appeared to be stronger among participants with body mass index (BMI) < 25 kg/m2 compared to overweight/obese participants. As for the predictive performance, CVAI had the largest C-statistic (0.700, 95% CI 0.672-0.728) compared to VAI, LAP, WC, and BMI (C-statistic: 0.535 to 0.670, all P for comparison < 0.05). When the abdominal obesity index was added to the basic risk model, the CVAI index also showed the greatest incremental risk stratification (C-statistic: 0.751 vs. 0.701, P < 0.001; IDI: 4.3%, P < 0.001; NRI: 26.6%, P < 0.001).

CONCLUSIONS

This study provided additional evidence that all abdominal obesity indices were associated with the risk of CV events and highlighted that CVAI might be a valuable abdominal obesity indicator for identifying the high risk of CV events in Chinese populations with T2D. These results suggest that proactive assessment of abdominal obesity could be helpful for the effective clinical management of the diabetic population.

Lipid accumulation product as useful predictors of stroke: A correlation analysis between lipid accumulation index/cerebral vascular hemodynamics indexes and risk factors of stroke in 3264 people undergoing physical examination in Xinjiang

OBJECTIVE

To investigate the relationship between lipid accumulation index and cerebral hemodynamic integral value in 3264 people undergoing physical examination, so as to analyze the correlation between different lipid accumulation product index (LAP) levels and stroke risk factors.

METHODS

This cross-sectional study was conducted from January to December 2019 on 3264 adults at the age of 19 to 85 living in Urumqi, Xinjiang. The stroke related risk factors were evaluated by the questionnaire survey. The enrolled subjects were divided into Q1 group (n = 817), Q2 group (n = 815), Q3 group (n = 816) and Q4 group (n = 816) according to the quartile site at a low-to-high-score manner.

RESULTS

The proportion of males was significantly higher than that of females in Q2, Q3, and Q4 groups. The proportion of middle-aged people and the elderly in Q2, Q3, and Q4 groups was significantly higher than that of youths (P < .05). The proportion of patients with history of hypertension, hyperlipidemia, physical inactivity, and smoking, and the levels of systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, high-density cholesterol, low-density cholesterol, triglyceride, body mass index, waist circumference increased with the increase of LAP level in different groups (P < .05). On both sides of the cerebral hemodynamic integral value (CVHI) index, Vmean, Vmax, Vmin showed a decreasing trend whereas peripheral resistance, pulse velocity, Zcv, dynamic resistance, critical pressure level, difference between diastolic and critical pressure showed an increase trend with the increase of LAP level. The normal rate of CVHI in 4 groups (>75 points) was 97.4%, 89.7%, 87.0, and 80.8%, respectively, showing a decreasing trend. Logistic regression results showed that the higher the LAP, the higher the abnormal risk of CVHI.

CONCLUSION

There is a positive correlation between LAP and CVHI, the higher the LAP, the higher the risk of CVHI abnormality, which should be concerned seriously.

Association Between Four Anthropometric Indexes and Metabolic Syndrome in US Adults

OBJECTIVE

To study the association between anthropometric indexes [lipid accumulation products (LAP), visceral obesity index (VAI), triglyceride and glucose index (TyG) and waist triglyceride index (WTI)] and metabolic syndrome (MetS) in a representative sample of American adult population surveyed by National Health and Nutrition Examination Survey (NHANES).

METHODS

Cross-sectional data from the NHANES were used. Participants were adults aged 18-80 y from 1996-2006. MetS were defined by the updated National Cholesterol Education Program/Adult Treatment Panel III criteria (NCEP-ATP III) for Americans. Receiver operating characteristic (ROC) curve was drawn and the areas under the curve (AUC) were used to assess the ability of these indexes in screening MetS. Statistical differences among the AUC values of these indexes were compared. The association between the anthropometric indexes and MetS was investigated using weighted multivariable-adjusted logistic regression.

RESULTS

560 (35.2%) males and 529 (26.4%) females were diagnosed with MetS. LAP was the strongest predictor of MetS for men (AUC=0.87, 95% CI 0.85-0.89), and also was the strongest for women [AUC=0.85, 95% confidence interval (CI) 0.83-0.86], according to the ROC curve analysis. In men, differences in AUC values between LAP and other anthropometric indicators were also significant (all P<0.001). In women, there was a significant difference in AUC values between LAP and WTI (P<0.001), but differences in AUC values between LAP and TyG, VAI were not significant.

CONCLUSION

The present study indicated that LAP is a better predictor in the clinical setting for identifying individuals with MetS in the American adult population.

Comparison of anthro-metabolic indicators for predicting the risk of metabolic syndrome in the elderly population: Bushehr Elderly Health (BEH) program

BACKGROUND

Metabolic syndrome (MetS) is a cluster metabolic disorder that includes central obesity, insulin resistance, hypertension, and dyslipidemia, and is highly associated with an increased risk of developing non-communicable diseases (NCDs). This study aimed to compare the reliability of anthro-metabolic indices [visceral adiposity index (VAI), body roundness index (BRI), and a body shape index (BSI), body adiposity index (BAI), lipid accumulation product (LAP), waist to hip ratio, and waist to height ratio] in predicting MetS in Iranian older people.

METHODS

This cross-sectional study was conducted based on the data of 2426 adults aged ≥60 years that participated in the second stage of the Bushehr Elderly Health (BEH) program, a population-based prospective cohort study being conducted in Bushehr, Iran. MetS was defined based on the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The receiver operating characteristic (ROC) curve analysis was used to assess predictive performance of anthro-metabolic indices and determine optimal cutoff values. Logistic regression analysis was applied to determine the associations between MetS and indices.

RESULTS

2426 subjects (48.1% men) with mean ± SD age of 69.34 ± 6.40 years were included in the study. According to ATP III criteria, 34.8% of men and 65.2% of women had MetS (P < 0.001). Of the seven examined indices, the AUCs of VAI and LAP in both genders were higher than AUCs of other anthro-metabolic indices. Also, in general population, VAI and LAP had the greatest predictive power for MetS with AUC 0.87(0.86-0.89) and 0.87(0.85-0.88), respectively. The lowest AUC in total population belonged to BSI with the area under the curve of 0.60(0.58-0.62). After adjusting for potential confounders (e.g. age, sex, education, physical activity, current smoking) in the logistic regression model, the highest OR in the total population was observed for VAI and LAP, which was 16.63 (13.31-20.79) and 12.56 (10.23-15.43) respectively. The lowest OR for MetS was 1.93(1.61-2.30) for BSI.

CONCLUSION

This study indicated that both VAI and LAP are the most valuable indices among the anthro-metabolic indices to identify MetS among the elderly in both genders. So, they could be used as proper assessment tools for MetS in clinical practice. However, the cost-benefit of these indices compared to the ATP III criteria need further studies.

Children's Lipid Accumulation Product Combining Visceral Adiposity Index is a Novel Indicator for Predicting Unhealthy Metabolic Phenotype Among Chinese Children and Adolescents

PURPOSE

The predictive capacity between children's lipid accumulation product (CLAP) combining visceral adiposity index (VAI), CLAP, and VAI with metabolically unhealthy phenotype remained unclear. This study aimed to compare the ability of CLAP combining VAI, CLAP, VAI and traditional adiposity indicators (body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR)) to predict metabolically unhealthy phenotype among Chinese children and adolescents.

PATIENTS AND METHODS

In the cross-sectional study, 1714 children and adolescents aged 12 to 18 were selected by random cluster sampling, underwent a questionnaire survey, physical examination, biochemical tests and body composition was measured by bioelectrical impedance analysis (BIA). Participants were divided into four phenotypes according to BMI and metabolic syndrome components. The logarithmic CLAP (LnCLAP), VAI, BMI, WC, WHtR and WHR were standardized for sex and age using the z-score method (standardized variables: LnCLAP-z, VAI-z, BMI-z, WC-z, WHtR-z and WHR-z).

RESULTS

LnCLAP-z ≥ 1, VAI-z ≥ 1, WC-z ≥ 1, and WHR-z ≥ 1 increased the risk of metabolically unhealthy normal-weight phenotype (the OR and 95% CI were 4.18 (1.75-10.02), 24.05 (12.79-45.21), 6.17 (1.14-33.51), 2.69 (1.07-6.72), respectively), LnCLAP-z ≥ 1, VAI-z ≥ 1 and WC-z ≥ 1 increased the risk of metabolically unhealthy overweight or obese phenotype (the OR and 95% CI were 2.67 (1.40-5.09), 10.30 (3.03-35.03), 2.19 (1.18-4.09), respectively). The area under the ROC curve (AUC) for CLAP combining VAI in the prediction of the metabolically unhealthy phenotype were 0.837 (0.776-0.899) and 0.876 (0.834-0.918) for boys and girls with normal-weight, 0.853 (0.803-0.903) and 0.794 (0.711-0.878) for boys and girls with overweight and obese (all P < 0.001), which were higher than CLAP, VAI, BMI, WC, WHtR and WHR.

CONCLUSION

Among Chinese children and adolescents, CLAP combining VAI was a more effective indicator than CLAP, VAI and traditional adiposity indicators in predicting unhealthy metabolic phenotype.

Associations between traditional and non-traditional anthropometric indices and cardiometabolic risk factors among inpatients with type 2 diabetes mellitus: a cross-sectional study

Objective

We aimed to evaluate whether traditional and non-traditional adiposity indicators are associated with cardiometabolic risk factors among adult patients with type 2 diabetes mellitus (DM).

Methods

In this cross-sectional study among 240 inpatients with type 2 DM, we determined traditional anthropometric indicators including body mass index, waist circumference, hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio, and non-traditional anthropometric indicators including lipid accumulation product (LAP), visceral adiposity index (VAI), deep abdominal adipose tissue (DAAT), and Després indices. Lipid profile, fasting blood glucose, glycated hemoglobin (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured to evaluate cardiometabolic parameters.

Results

In overweight patients, DAAT was positively correlated with total triglycerides. LAP was negatively correlated with serum HDL-C levels. WHR and DAAT were associated with total triglycerides, HbA1c, total cholesterol, total cholesterol/HDL-C, and total triglycerides/HDL-C, after adjustment for age and duration of disease. VAI, DAAT, LAP, and Després index were significant determinants of lipid profile and SBP.

Conclusion

Traditional and non-traditional anthropometric indices are associated with cardiometabolic risk factors in patients with type 2 DM.

Association Between Lipid Accumulation Product and Target Organ Damage in Elderly Population: The Northern Shanghai Study

Introduction

Lipid accumulation product (LAP), calculated from waist circumference (WC) and triglycerides (TG), is a novel index that correlates cardiovascular disease. We aimed to investigate the relationship between LAP and target organ damage (TOD) in elderly Chinese community-dwelling individuals.

Materials and Methods

We enrolled 3363 participants whose age was ≥65 years old. TOD, including left ventricular hypertrophy (LVH), arterial stiffness (AS), lower extremity atherosclerotic (LEA), micro-albuminuria (MAU) and chronic kidney disease (CKD), was measured using standard methods. LAP was calculated as (WC–65) × TG in men and (WC–58) × TG in women. Both quartiles and continuation of LAP were analyzed.

Results

Age-sex adjusted partial correlation analysis showed that LAP was significantly associated with CVD risk factors. With the first quartile (Q1) as a reference, in univariate logistic regression, the fourth quartile (Q4) of LAP was associated with all TOD. In multivariate model, Q4 of LAP was only associated with an increased risk of AS (odds ratio (OR) = 1.88, 95% confidence interval (CI): 1.37–2.58, P_{for trend}< 0.001), MAU (OR = 1.33, 95% CI: 1.01–1.75, P_{for trend}= 0.02) and CKD (OR = 2.39, 95% CI: 1.39–4.12, P_{for trend}< 0.001). But, Q4 of LAP was not associated with an increased risk of LVH (OR = 1.19, 95% CI: 0.85–1.65, P_{for trend}= 0.25) or LEA (OR = 0.87, 95% CI: 0.58–1.29, P_{for trend}= 0.96). Similar associations were found when analyzed continuously.

Conclusion

The novel metabolic parameter LAP is significantly and independently associated with an increased risk of arterial stiffness, chronic kidney disease and micro-albuminuria in Chinese community-dwelling elderly individuals.

Design, synthesis and lipid-lowering activities of penipyridone derivatives

On the basis of our earlier discovered natural product penipyridone G with potential lipid-lowering utility, 35 penipyridone derivatives were designed, synthesized and characterized. Based on the oleic acid-induced HepG2 cell lipid accumulation model, compounds 12c, 14, 15f, 15k, 15o, 15p and 16f showed potent lipid-lowering activities among the synthetic compounds at 10 μM. In particular, compounds 4, 15k, 15o showed significant activities on inhibiting lipid accumulation in insulin resistant HepG2 cells, and these three compounds were safe and non-toxic within the concentration range of 400 μM. In comparison, 15o possessed the best lipid-lowering activity. Compared with the vehicle group, the triglyceride inhibition rate of 15o was about 30.2%, and the total cholesterol inhibition rate was about 14.8% at 20 μM, which was equipotent to Simvastatin. Our research indicates that 15o may serve as a promising lead compound for the development of hypolipidemic drugs.

Association of neighborhood greenness exposure with cardiovascular diseases and biomarkers

AIM

Living in areas with neighborhood greenness may be associated with the incidence of cardiovascular diseases (CVDs). However, little evidence in this regard has emerged from developing countries. In the present study, we examined neighborhood greenness associated with CVDs and the lipid accumulation product (LAP) and pulse pressure (PP) in China.

METHODS

We undertook our analysis using a community cross-sectional survey conducted in Longzihu District of Bengbu from July to August 2015. We measured triglyceride levels, waist circumference, and blood pressure. To assess exposure to neighborhood greenness, we used the average normalized difference vegetation index (NDVI) at 1,000-, 1,500-, and 2,000-m buffers in the participant community. We employed generalized mixed models to determine the association among neighborhood greenness, CVDs, LAP, and PP. We conducted stratified analysis by age, gender, income, and education. We assessed the potential mediating effects of road proximity and physical activity on greenness and CVDs, PP, and LAP.

RESULTS

The highest tertiles of NDVI_1500-m were steadily and significantly associated with lower odds of CVDs prevalence: the adjusted OR of such prevalence was 0.612 (95% CI, 0.462-0.811); higher NDVI was significantly associated with lower PP levels. The NDVI was strongly associated with CVDs prevalence among participants who were male and had high income. Ambient road proximity significantly mediated 9.7% of the estimated association between greenness and PP, there was no evidence of mediation effects for physical activity.

CONCLUSIONS

Higher neighborhood greenness could have a beneficial effect on CVDs and biomarkers. There were higher associations between residential greenness and CVDs among male and higher-income individuals; road proximity partially mediated the observed association between greenness and PP.

Evaluation of Anthropometric Indices and Lipid Parameters to Predict Metabolic Syndrome Among Adults in Mexico

BACKGROUND

Metabolic syndrome (MetS) is a cluster of conditions that increases the risk of cardiovascular disease (CVD) and is related to genetic background, dietary habits, and lifestyle. Anthropometric indices and lipid parameters have been shown to be simple and useful tools in clinical practice for predicting MetS. The aim of the present study was to evaluate the differential magnitudes of anthropometric characteristics (waist circumference and body mass index [BMI]) and lipid parameters, namely, lipid accumulation product (LAP), cardiometabolic index (CMI), and Castelli Risk Index (CRI-I), to estimate MetS, usingappropriate cut-off values, among adults from a public hospital in Yucatan, Mexico.

METHODS

A cross-sectional study among 250 adults (77 men, 173 women) was carried out in the Regional High Speciality Hospital of the Yucatan Peninsula (HRAEPY) in Merida, Yucatan. MetS was diagnosed using standard criteria (central obesity, arterial hypertension, hyperglycemia, and dyslipidemia), and derived parameters (LAP, CMI, and CRI-I) were calculated. Binary logistic regression analysis-based receiver operating characteristics (ROC) curves were used to predict MetS.

RESULTS

Of the 250 participants, 48% had MetS. High prevalences of overweight (35.2%) and obesity (48.8%) were found in the sample. The CMI and LAP were found to be the best parameters in the prediction of MetS in men and women. The optimal cut-off values of the parameters were higher in men and decreased with advancing age.

CONCLUSION

The CMI and LAP were shown to be the most effective indicators to diagnose MetS among adults from Yucatan, Mexico.

Lipid Accumulation Product is Associated with Urinary Albumin-creatinine Ratio in Chinese Prediabitic Population: A Report from the REACTION Study

BACKGROUND

Lipid accumulation product (LAP) as a powerful marker of visceral obesity is an independent risk factor of chronic kidney disease. The present study attempted to explore the association between LAP and albuminuria in prediabetic individuals.

METHODS

We conducted a cross-sectional study and enrolled 26,529 participants with prediabetes over 40 years old with prediabetes from seven provinces in China. LAP was calculated from waist circumference and fasting triglycerides. Elevated albuminuria was defined by urinary albumin-creatinine ratio (uACR) ≥30 mg/g. Propensity score matching was applied to reduce bias, comparison between LAP and other traditional visceral obesity indices was performed and multiple logistic regression models were conducted to assess the association between LAP and albuminuria in the prediabetic population.

RESULTS

Individuals with uACR ≥30 mg/g were older and had higher BP, BMI, WC, TG, fasting insulin, glycohemoglobin and LAP, as well as lower eGFR and HDL level. Multiple logistic regression analysis showed elevated LAP was associated with increased odds of albuminuria (OR [95%CI]_{Q2 vs Q1} 1.09 [0.94, 1.27], OR [95%CI]_{Q3 vs Q1} 1.13 [0.97, 1.31], OR [95%CI]_{Q4 vs Q1} 1.42 [1.21, 1.67], P for trend=0.018), and superior over waist-to-hip ratio or waist-to-height ratio. Stratification indicated that the prediabetic population with higher LAP level and characterized by female gender, middle age, being overweight, and rise in blood pressure were more likely to have increased uACR.

CONCLUSION

Elevated level of LAP was associated with increased albuminuria in the prediabetic population in China.

Sprint interval training vs. combined aerobic + resistance training in overweight women with type 2 diabetes

BACKGROUND

Aerobic and resistance training have known efficacy for treating type2 diabetes (T2D). Less is known about interval training in this population. We examined the effects of sprint interval (SIT) and combined aerobic + resistance (COMB) training on HbA1C and (Primary Outcome) in participants with T2D. Secondary outcomes included HOMA-IR and standard clinical chemistries. Exploratory/Tertiary included immerging cardiovascular disease risk indices.

METHODS

Participants (N.=52; 45-60y, BMI>30kg/m², HbA1c, ≥6.5%) were randomly assigned to either SIT (N.=17), COMB (N.=17) or usual care control (Control, N.=18) for 10-weeks. Data were analyzed by ANOVA and effect sizes estimated using Cohen's D (CD).

RESULTS

We observed significant reductions in HbA1c for SIT (-1.82%, 95% CI, -2.50, -1.14) and COMB (-1.24%, 95% CI, -2.19, -0.29), but not Control (0.02%, 95% CI, -0.67, 0.71). Secondary outcome analysis demonstrated significant reductions in HOMA-IR for SIT (-4.89, 95% CI, -6.94, -2.83) and COMB training (-2.90, 95% CI, -5.00, -0.79), but not Control (-0.44, 95% CI, -3.44, 2.46). Effect size estimates and accompanying confidence interval bound were deemed "large" for HBA1c and moderate-to-large for HOMA-IR. Non-significant changes for the Control group were deemed "trivial." Both analyses were significant vs. Control. Similar patterns were observed for most standard laboratory measures and tertiary outcomes.

CONCLUSIONS

Our results demonstrated that SIT and COMBO training are effective exercise training regimens in overweight women with T2D independently of changes in body mass.

Mediterranean Personalized Diet Combined with Physical Activity Therapy for the Prevention of Cardiovascular Diseases in Italian Women

Cardiovascular diseases (CVDs) and inflammatory risk indexes are used to calculate the exposure to morbidity. Most of them are suggested by the American College of Cardiology/American Heart Association to predict the risk of CVDs diagnosis in primary prevention, instead of treating the ongoing pathology. Prevention starts from habit changes with the prescription of diet and physical activity (PA). The aim of the study is to investigate the effectiveness of a personalized Mediterranean Diet (MD) and a PA intervention, on the risk indexes Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP) and Fatty Liver Index (FLI) in a population of women at risk of CVDs with different pathological conditions. After treatment, patients achieved the best results in body composition (BC) and laboratory tests. The BC analysis showed a significant reduction of total body Fat Mass (FM). CVDs risk indexes significantly decreased, except for Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (PLR). The reduction of the CVDs indexes associated with lipid profile was linked to both weight and FM decrease. AIP and LAP were significantly reduced when losing fat mass and body weight, respectively. A personalized MD therapy plus a PA program led to body weight loss, BC remodelling and risk indexes reduction.

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

Background: Nonobese individuals with disproportionate body fat distribution are also vulnerable to dysglycemia. This study aimed to evaluate the association between three visceral adiposity surrogates and impaired fasting glucose (IFG) in nonobese Chinese individuals. Methods: A total of 70,200 nonobese adults without diabetes were included in this analysis. Two diagnostic criteria (IFG-ADA and IFG-WHO) were used to define IFG. The values of the visceral adiposity index, lipid accumulation product index (LAP), and cardiometabolic index (CMI) were calculated. Multivariable logistic analysis was used to evaluate the association between these surrogates and IFG. Results: Among the three indicators, only LAP and CMI were positively correlated with fasting plasma glucose (all P < 0.001). After fully adjusting for confounders, only LAP and CMI exhibited significant associations with IFG. For women, the odds ratios (ORs) for IFG-ADA in the highest quartile of the LAP and CMI were 1.967 (95% confidence interval [CI]: 1.645-2.353) and 1.594 (95% CI: 1.383-1.836), respectively; and were 2.025 (95% CI: 1.597-2.567) and 2.017 (95% CI: 1.647-2.470), respectively, for IFG-WHO (all P < 0.001). For men, the ORs for IFG-ADA of the LAP and CMI were 1.503 (95% CI: 1.233-1.833) and 2.045 (95% CI: 1.752-2.388), respectively; and were 1.534 (95% CI: 1.174-2.005) and 2.541 (95% CI: 2.025-3.188), respectively, for IFG-WHO (all P < 0.001). Conclusions: The LAP and CMI, cost-effective and simple visceral adiposity surrogates, are strongly associated with IFG in nonobese Chinese individuals. These surrogates might be potential targets to monitor for the recognition and management of excess visceral adiposity in nonobese individuals with prediabetes.

Urine Glucose Excretion Attenuates the Association Between Lipid Accumulation Product and Serum Uric Acid in Subjects with Prediabetes

PURPOSE

Obesity is known to be strongly associated with hyperuricemia. Moreover, the impact of urine glucose excretion (UGE) on serum uric acid (UA) levels has gained much more attention in recent years. Yet concern is raised about whether UGE influences the relationship between obesity and hyperuricemia. The aim of this study was to assess the effect of UGE on the association between lipid accumulation product (LAP), a novel marker of visceral adipose accumulation, and UA in subjects with prediabetes.

MATERIALS AND METHODS

Data were obtained from a cross-sectional study. A total of 3645 subjects with prediabetes were included in the present study. The separate and joint associations of LAP and UGE with hyperuricemia were examined using logistic regression analyses.

RESULTS

LAP was positively associated with UA in both genders. Subgroup analysis based on UGE revealed that the association was strongest in subjects with low UGE (r = 0.328, p < 0.001), whereas the positive association was weakened, but still remained significant in subjects with moderate and high UGE. High LAP was significantly associated with an increased odds ratio for hyperuricemia after adjustment for potential confounders in the overall population (OR = 2.07, 95% CI: 1.66-2.58, p < 0.001). However, a downward trend in odds ratios for hyperuricemia was observed across UGE categories. In addition, the joint association analysis confirmed that the relationship between LAP and hyperuricemia was attenuated by UGE.

CONCLUSION

The positive association between LAP and UA appears to be attenuated by UGE, indicating that promoting UGE may be an effective strategy for controlling UA levels, especially for people with obesity who are at increased risk for hyperuricemia.

Association of lipid accumulation product trajectories with 5-year incidence of type 2 diabetes in Chinese adults: a cohort study

Background

Lipid accumulation product (LAP) is an index describing the overaccumulation of lipid. Baseline LAP was used for type 2 diabetes (T2D) prediction in previous studies. But the longitudinal trajectories of LAP, which reflect the efficacy of patients' lipid-lowering treatment and lifestyle improvement, have rarely been studied. The aim of this study is to explore the association of lipid accumulation product trajectories with 5-year incidence of type 2 diabetes.

Methods

This cohort study included 4508 non-diabetic participants with a median age of 42 years. Using the group-based trajectory modeling (GBTM), LAP from 2011 to 2016 were determined and identified as three trajectories: low (n = 3639), moderate (n = 800), and high (n = 69). Baseline LAP was divided into groups by percentiles and tertiles respectively for the comparison of LAP trajectories. The associations between 5-year T2D incidence and LAP trajectories and baseline LAP were both assessed by generalized linear models.

Results

From 2011 to 2016, 169 participants developed T2D (the 5-year incidence of 3.8%). For participants with low, moderate, and high trajectories, the incidence of T2D was 2.1, 10.0, and 15.9%, respectively. A significant trend was observed in the relative risks (RRs) of 5-year incident T2D in participants with moderate (RR, 1.95; 95% CI: 1.41-2.70) and high LAP trajectory (RR, 2.20; 95% CI: 1.12-4.30) in the fully adjusted model (p for trend< 0.001). However, there were no statically significant trends in RRs in different tertiles of baseline LAP found after full adjustments.

Conclusion

The trajectories of LAP has an independent effect on 5-year T2D incidence beyond LAP measured at baseline.

The effects of elastic resistance band training and green coffee bean extract supplement on novel combined indices of cardiometabolic risk in obese women

The main purpose of this study was to investigate the effects of elastic resistance band training (ERBT) and green coffee bean extract (GCBE) supplement on novel cardiometabolic indices in obese women. To this end, a total number of 60 obese women aged 30-50 years with a body mass index of > 30 kg/m² were selected for inclusion in this study and then they were randomly assigned to one of the following four groups: placebo (n = 15), GCBE supplement (n = 15), GCBE supplement + ERBT (n = 15), and placebo + ERBT (n = 15). Each commercially prepared GCBE supplement capsule used in this study contained 500 mg of GCBE supplement and it was also claimed by the manufacturer to have 50% chlorogenic acid (CGA) (250 mg). The participants in the placebo + ERBT and GCBE supplement + ERBT groups attended an 8-week ERBT program, 3 sessions / week, and 60 min each session. In the GCBE supplement + ERBT group, Framingham risk score (P = 0.018), atherogenic index of plasma (P = 0.003), and metabolic syndrome severity score (P = 0.001) significantly decreased. Taken together, the results of the present study supported the importance of supplemental and resistance-type training in improving obesity and novel cardiometabolic risk scores, despite the fact that longer nutritional and exercise interventions could enhance some cardiometabolic risk scores in obese women.

The Adipokine Profile and the Cardiometabolic Risk in Non-Obese Young Adults

Background

Young, non-obese adults are considered at low risk for cardiometabolic diseases, although markers of an unhealthy metabolic state are not uncommon findings in this population. Adipose tissue dysfunction, evaluated by the adipokine profile, significantly influences lipid and glucose metabolism and low-grade systemic inflammation.

Aims

To determine the relation between adipose tissue dysfunction and the already confirmed cardiometabolic risk indicators, including the atherogenic index of plasma, lipid accumulation product, homeostatic model assessment of insulin resistance, and the low-grade inflammation markers, namely, interleukin 6 and high-sensitivity C-reactive protein.

Study Design

Cross-sectional study.

Methods

We recruited 93 non-obese, healthy young adults. Anthropometric, lipid profile, inflammatory markers, and adipokines were measured. An abnormal adipokine profile (high leptin-to-adiponectin ratio) was considered as a marker of a dysfunctional adipose tissue. The correlation between the leptin-to-adiponectin ratio and the anthropometric measurements, atherogenic index of plasma, lipid accumulation product, homeostatic model assessment of insulin resistance, interleukin 6, and high-sensitivity C-reactive protein was determined.

Results

We found a direct correlation between the abnormal adipokine profile and the cardiometabolic risk indicators mentioned above, except for the low-grade inflammatory markers. In the regression model derived from our data, the leptin-to-adiponectin ratio was best correlated with the unfavorable plasma lipid profile, as estimated by the atherogenic index of plasma (r=0.097, confidence interval=0.015-0.180, p=0.021). A significantly higher leptin-to-adiponectin ratio was found in the insulin-resistant group (p=0.012) and in the highest lipid accumulation product quartile (p=0.032).

Conclusion

In a non-obese young population, the high rate of leptin-adiponectin may be a good predictor of cardiovascular and metabolic risk assessment.

The impact of the sleep duration on NAFLD score in Korean middle-aged adults: a community-based cohort study

BACKGROUND

Accumulated evidences indicates that sleep duration and sleep quality may potentially trigger the development of non-alcoholic fatty liver disease (NAFLD), but no studies have explored this causality. In this study, we aimed to investigate the effect of sleep duration on the incidence of NAFLD in Korean middle-aged adults.

METHODS

All participants were selected from the cohort of the Korean Genome and Epidemiology Study (KoGES) for a 10-year period. NAFLD was defined by Fatty Liver Index (FLI), NAFLD liver fat score (NLFS), Hepatic Steatosis Index (HSI) and Lipid Accumulation Product (LAP). Multiple logistic regression analysis was used to assess the relationship between sleep duration and NAFLD defined by NAFLD scores. ANCOVA and Spline curve was also used to verify the differences in means of NAFLD scores according to the four sleep duration groups.

RESULTS

In comparison with those of individuals in the reference group, the OR (95% CI) for NAFLD was 2.230 (1.304-3.813) for group of people who slept more than 8 h, 1.869 (1.298-2.691) for 7-8 h after adjusting for several confounding factors. The odds ratio for the incidence of NAFLD was 1.462 (1.029-2.077) for the group of people who sleep more than 8 h, 1.271 (1.001-1.615) for 7-8 h after adjusting for age, sex, BMI, SBP, DBP, TG, HDL, FDG, smoking, physical activity, daytime napping and night-time shifting (p < 0.01).

CONCLUSION

These findings indicate a relationship between long sleep duration and the elevation of NAFLD scores and support the causality of sleep duration and incidence of NAFLD in Korean middle-aged adults.

Usefulness Of Surrogate Markers Of Body Fat Distribution For Predicting Metabolic Syndrome In Middle-Aged And Older Korean Populations

BACKGROUND

Obesity markers, the lipid accumulation product (LAP), visceral adiposity index (VAI), triglyceride and glucose (TyG) index, and waist-to-height ratio (WHtR) are useful for assessing the risk of obesity-related cardiovascular disease. However, no previous study has assessed the usefulness of these four indices as predictors of metabolic syndrome among middle-aged and older Korean populations.

PURPOSE

To investigate the usefulness of LAP, VAI, TyG index, and WHtR as predictors of metabolic syndrome in middle-aged and older Korean populations.

METHODS

This study included 15,490 male and female adults aged 40 years or older who underwent a medical check-up in a general hospital located in a Korean metropolitan area between January 2015 and December 2016. The diagnostic criteria for metabolic syndrome suggested by the American Heart Association/National Heart Lung and Blood Institute were used. LAP, VAI, and TyG index were computed based on the suggested mathematical models. WHtR was computed by dividing waist circumference by height. The independent sample t-test, one-way analysis of variance, Scheffe test, chi-square test, Pearson's correlation analysis, and logistic regression were used to analyze the data.

RESULTS

LAP, VAI, TyG index, and WHtR were significantly related to metabolic syndrome in both sexes. Receiver operating characteristic curve analysis showed the following optimal cutoffs for LAP, VAI, TyG index, and WHtR: 33.97, 1.84, 8.81, and 0.51, respectively. After adjusting for latent confounding variables (age, systolic blood pressure, diastolic blood pressure, and waist circumference), LAP, VAI, TyG index, and WHtR were significantly correlated with metabolic syndrome. Area under the curve (AUC) values based on ROC curves showed that LAP, VAI, TyG index, and WHtR were reliable predictors of metabolic syndrome. LAP had the greatest AUC, suggesting that it was a more useful predictor than the other markers (AUC=0.917, 95% confidence interval: 0.913-0.922).

CONCLUSION

LAP, VAI, TyG index, and WHtR are useful predictors of metabolic syndrome in middle-aged and older Koreans, but LAP had the greatest diagnostic accuracy.

Lipid accumulation product in relation to 10-year cardiovascular disease incidence in Caucasian adults: The ATTICA study

BACKGROUND AND AIMS

The lipid accumulation product (LAP) is an index describing lipid over-accumulation based on waist circumference (WC) and fasting triglycerides, and can outperform the body mass index (BMI) in recognizing cardiovascular disease (CVD) risk. We aimed to explore the association of LAP with long-term CVD risk and compare its CVD-predictive value against common anthropometric indices/ratios of obesity.

METHODS

ATTICA is a prospective, population-based cohort that recruited 3042 adults without pre-existing CVD from the Greek general population (age 18-89 years; 1514 men). The 10-year study follow-up (2011-2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). Baseline LAP (cm·mmol/L) was calculated and analyzed in relation to the 10-year CVD incidence.

RESULTS

In total, 317 CVD cases (15.7%) were documented during the follow-up. Baseline LAP showed a significant positive association with the 10-year CVD incidence, even after adjusting for hypertension, diabetes, hypercholesterolemia, smoking, physical activity, Mediterranean diet adherence, and key pro-inflammatory biomarkers (Hazard Ratios per 10 cm·mmol/L of LAP ranging from 1.1 to 1.21, p = 0.04). Moreover, LAP predicted the 10-year CVD study incidence better than common obesity indices (BMI, WC, waist-to-hip, waist-to-height ratio).

CONCLUSIONS

These findings support a positive association between LAP and long-term CVD incidence in CVD-free Caucasian adults from the general population.

Estimate of prevalent diabetes from cardiometabolic index in general Chinese population: a community-based study

Background

Cardiometabolic index (CMI) defines adiposity based on triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and waist-to-height ratio (WHtR). This newly proposed metric has been used to detect multiple cardiovascular risk factors, but data relative to diabetes in the general population are lacking. This study aims to validate CMI’s utility of discriminating diabetes and compares it with other indexes among general Chinese population.

Methods

Analyses were based on a cross-sectional study of 11,478 participants that underwent assessment of metabolic and anthropometric parameters in rural areas of northeastern China in 2013. CMI was calculated by TG/HDL-C × WHtR. Multivariate logistic regressions were performed to clarify CMI’s association with diabetes, ROC analyses were engaged to investigate CMI’s discriminating ability for diabetes.

Results

The prevalence of diabetes was 9.93% in males while 10.76% in females, and increased with CMI’s increment. After full adjustment, each SD increment of CMI had odds ratios (ORs) for diabetes of 1.471 (1.367–1.584) and 1.422 (1.315–1.539) in females and males, respectively. Compared with bottom categories of CMI, the top quartiles had ORs of 3.736 (2.783–5.015) in females and 3.697 (2.757–4.958) in males. The ROC results showed an excellent discriminating power of CMI (AUC: 0.702 for females, 0.664 for males).

Conclusions

An increasing CMI was correlated with higher odds of diabetes, supporting CMI as a useful and economic measure to screen and quantify diabetes in general Chinese population. Monitoring and promoting achievement of dyslipidemia and abdominal obesity based on CMI may improve subclinical and cardiovascular outcomes.

The effect of lipid accumulation product and its interaction with other factors on hypertension risk in Chinese Han population: A cross-sectional study

OBJECTIVES

Lipid accumulation product (LAP) is a simple and effective indicator that reflects visceral obesity. This study aimed to compare the significance of LAP in predicting hypertension risk with other obesity indices, and to evaluate the interactive effects of LAP and smoking, family history of hypertension on hypertension risk in Chinese Han adults.

METHODS

A community based cross-sectional study was performed in Bengbu, China. Participants received face-to-face questionnaire survey, anthropometric tests and laboratory examinations. Relevant indicators that reflect obesity including BMI (body mass index), waist-to-height ratio (WHtR) and LAP were calculated. Multivariate logistic regression analysis was applied to explore the association between LAP and hypertension risk. The area under the receiver-operating characteristics curves (AUC) of LAP, BMI, and WHtR were calculated and then compared. Interactive effect was evaluated by relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI).

RESULTS

A total of 1777 participants were enrolled, and the prevalence of hypertension was 24.4% (n = 433). There was a significant increase in hypertension risk with LAP levels in the fourth quartile as compared with the bottom quartile (OR: 3.31, 95%CI: 1.76-6.25). The AUC of LAP was significantly different than that of BMI in males (Z = 2.158, p = 0.0309) and females (Z = 3.570, p = 0.0004), while only performed better in females as compared with that of WHtR (Z = 2.166, p = 0.0303). LAP was significantly interacted with family history of hypertension on hypertension risk both in males (RERI: 1.07, 95%CI: 0.09-2.05; AP: 0.33, 95%CI: 0.23-0.44; SI: 1.92, 95%CI: 1.53-2.41) and females (RERI: 0.80, 95%CI: 0.07-1.53; AP: 0.25, 95%CI: 0.11-0.39; SI: 1.59, 95%CI: 1.16-2.19). However, a significant interaction between LAP and smoking was only observed in males (RERI: 1.32, 95%CI: 0.15-2.75; AP: 0.40, 95% CI: 0.14-0.73).

CONCLUSION

Increased LAP was significantly associated with a higher risk of hypertension in Chinese Han adults. Moreover, the effect of LAP on predicting hypertension risk was better than that of other obesity indices. Our results also demonstrated interactive effects of LAP with smoking, family history of hypertension on hypertension risk.

Gender-specific contribution of cardiometabolic index and lipid accumulation product to left ventricular geometry change in general population of rural China

Background

Despite current interest in the unfavorable impact of cardiometabolic index (CMI) and lipid accumulation product (LAP) on diabetes and cardiovascular risk, information regarding the relation of CMI and LAP to left ventricular (LV) geometry has not been specifically addressed. We aimed to examine the hypothesis: (1) CMI and LAP represent an independent determinant of LV remodeling in general population of rural China; (2) there are gender differences in obesity-related alterations in terms of LV morphology.

Methods

The sample for this cross-sectional analysis included 11,258 participants (mean age 53.9 years; 54.0% females) who underwent assessment of basic metabolic and anthropometric parameters in rural areas of northeast China. Comprehensive echocardiography-defined LV geometric pattern was determined according to left ventricular mass index and relative wall thickness.

Results

The prevalence rate of eccentric and concentric LV hypertrophy (LVH) presented a proportional increase with elevated quartiles of CMI and LAP in a dose-response manner (all P < 0.005). When CMI and LAP were entered as a continuous variable in multivariable adjusted model, we observed the independent effect of 1 SD increment in CMI and LAP with the probability of eccentric and concentric LVH, while this relationship was more pronounced in females than in males. Likewise, the odds ratio comparing the top versus bottom quartiles of CMI were 2.105 (95%CI:1.600–2.768) for eccentric LVH and 2.236 (95%CI:1.419–3.522) for concentric LVH in females. Males in the highest CMI quartile exhibited a nearly doubled (OR:1.724, 95%CI:1.287–2.311) and 1.523-fold (95%CI:1.003–2.313) greater risk of eccentric and concentric LVH, respectively. Increasing LAP entailed a higher possibility of eccentric LVH by a factor of 3.552 and 1.768 in females and males, respectively. In contrast to females, where LAP fourth quartile and concentric LVH were positively associated (OR:2.544, 95%CI:1.537–4.209), higher LAP did not correlate with concentric LVH in males (OR:1.234, 95%CI:0.824–1.849).

Conclusions

CMI and LAP give rise to a new paradigm of accounting for gender difference in obesity-related abnormal LV geometry, an effect that was substantially greater in females. These two indices, acting in concert, may also be advantageous prognostically for refining cardiovascular risk stratification in individuals with LV remodeling.

Electronic supplementary material

The online version of this article (10.1186/s12872-018-0798-0) contains supplementary material, which is available to authorized users.

Anthropometric and central obesity indices as predictors of long-term cardiometabolic risk among Saudi young and middle-aged men and women

Objectives:

To investigate the prediction of long-term cardiometabolic risk using anthropometric and central obesity parameters.

Methods:

A total of 390 Saudi subjects (men 42.8%) aged 18-50 years were enrolled in a cross-sectional study in King Saud University, Riyadh, Kingdom of Saudi Arabia between August 2014 and January 2016. All participants were instructed to fast for 12 hours before taking blood samples for glucose and lipid panel analyses. A full anthropometric measurement and bioelectric impedance analysis was performed. The anthropometric and central obesity parameters were used for correlation with 30-year Framingham and life-time American College of Cardiology/American Heart Association risk scores. We used receiver operator characteristic curves to select the best predictors with the highest sensitivity and specificity.

Results:

The best discriminators of the long-term cardiometabolic risk among all the studied variables in men were the visceral adiposity index (VAI) (AUC=0.767), conicity index (CI) (AUC=0.817), and mid-arm muscular area (MAMA) (AUC=0.639). The best predictors for women were body mass index (AUC=0.912), waist circumference (AUC=0.752), and lipid accumulation product (AUC=0.632). The Kappa coefficient and 95% confidence interval ranged from 0.1 to 0.35, which suggests that there is a poor to fair agreement between these indices and cardiovascular risk scores.

Conclusion:

Long-term cardiometabolic risk can be predicted using simple anthropometric and central obesity indices, and these discriminators were not the same in Saudi men and women.

Visceral adiposity index, lipid accumulation product and intracranial atherosclerotic stenosis in middle-aged and elderly Chinese

We investigated the association of the newly established lipid accumulation product (LAP) and visceral adiposity index (VAI) with intracranial atherosclerotic stenosis (ICAS) in middle-aged and elderly Chinese. From June 2012 to January 2013, consecutive patients ≥40 years of age who underwent cerebral vascular imaging for various medical reasons were enrolled in this study. Multivariate logistic regression models were used to evaluate the correlation of VAI and LAP with the risk of ICAS. In total, 845 patients were included in the study. The prevalence of ICAS gradually increased in females and in all patients with advancing tertiles of VAI or LAP. After adjusting for potential risks, both the VAI and LAP were related to ICAS in females [VAI: odds ratio (OR) = 3.25, 95% confidence interval (95%CI) = 1.17–9.03, P = 0.024; LAP: OR = 4.11, 95%CI = 1.39–12.12, P = 0.011; tertiles 3 vs. 1]. The sensitivity, specificity, and positive predictive value (PPV) were 74.7%, 45.5%, and 84.4% for VAI (cut-off: 1.71) and 79.3%, 40.5%, and 84.1% for LAP (cut-off: 23.99). The same relationships in males were not significant. Both VAI and LAP were closely associated with an increased risk of ICAS in middle-aged and elderly Chinese females.

Lipid accumulation product is a powerful tool to predict non-alcoholic fatty liver disease in Chinese adults

Background

Non-alcoholic fatty liver disease (NAFLD), recognized as the liver manifestation of metabolic syndrome, is highly prevalent in the general population. Recent studies suggest that lipid accumulation product is significantly associated with metabolic abnormalities. The aim of this study was to assess the accuracy of lipid accumulation product (LAP) as an effective screening tool for diagnosing NAFLD in the general population.

Methods

A total of 40,459 subjects aged ≥18 years were enrolled in this cross-sectional study. LAP was calculated as [waist circumference (cm) – 65] × triglyceride concentration (mmol//L) in men and [waist circumference (cm) – 58] × triglyceride concentration (mmol/L) in women. Multiple logistic regression and receiver operating characteristic (ROC) analyses were performed.

Results

According to multiple logistic regression analyses, LAP was significantly associated with a higher prevalence and severity of NAFLD in both men and women. When assessed using ROC curve analyses, LAP exhibited high diagnostic accuracy for identifying NAFLD, and the areas under the curves (AUC) in men and women were 0.843 (95% CI 0.837, 0.849) and 0.887 (95% CI 0.882, 0.892), respectively. After further analyzed in different age groups, the diagnostic accuracy of LAP was found to be significantly better in younger age groups (aged 18-34 for men; aged 18-34 and 35-44 years for women) for both sexes.

Conclusions

LAP is significantly associated with the presence and severity of NAFLD, and has a high diagnostic accuracy for identifying NAFLD in the general population. The diagnostic accuracy of LAP was especially high among younger age groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12986-017-0206-2) contains supplementary material, which is available to authorized users.

Are visceral adiposity index and lipid accumulation product reliable indices for metabolic disturbances in patients with type 2 diabetes mellitus?

BACKGROUND

Visceral adiposity index (VAI) and Lipid accumulation product (LAP) are novel visceral adiposity indexes, proposed for the evaluation of cardiometabolic risk in adult population. Considering contradictory results obtained from many studies so far, we aimed to examine the potential benefit of applicability of VAI and LAP, over simple anthropometric indices and traditional lipid parameters in individuals with type 2 diabetes mellitus (DM2).

METHODS

A total of 180 DM2 (of them 50% females) and 119 controls who volunteered to participate in this cross-sectional study were enrolled. Anthropometric and biochemical parameters, as well as blood pressure were obtained. VAI and LAP were calculated.

RESULTS

Multivariate logistic regression analysis showed that high-density lipoprotein cholesterol (HDL-c), (P<.001), waist circumference (WC), (P=.027), age (P=.001), hypolipemic therapy (P=.024), and LAP (P=.005) were independent predictors of DM2 in adjusted models. In Receiver Operating Characteristic curve analysis, used to discriminate subjects with DM2 from those who did not have it, good accuracy of the applied procedures was only achieved with models which were consisted of parameters used in VAI (Body mass index, WC, HDL-c, triglycerides) and LAP (WC, triglycerides) indexes equations, respectively [Area under the curve (AUC)=0.819 and AUC=0.800, respectively], but not with VAI (AUC=0.781) and LAP (AUC=0.784) indexes themselves.

CONCLUSION

Visceral adiposity index and Lipid accumulation product may not be better than parameters that enter its equation in type 2 diabetes prediction.

Potential Lipid-Lowering Mechanisms of Biochanin A

Extensive studies have demonstrated that biochanin A (BCA) has a significant hypolipidemic effect. However, its mechanism of action is not clear. In this context, the effect of BCA on a high-fat diet (HFD)-induced hyperlipidemia in mice was determined. The results showed that treatment with a medium dose of biochanin A (BM) significantly decreased low-density lipoprotein cholesterol (LDL-C) 85% (from 1.196 ± 0.183 to 0.181 ± 0.0778 mM) and total cholesterol (TC) 39% (from 5.983 ± 0.128 to 3.649 ± 0.374 mM) levels, increased lipoprotein lipase (LPL) 96% (from 1.421 ± 0.0982 to 2.784 ± 0.177 U/mg protein) and hepatic triglyceride lipase (HTGL) 78% (from 1.614 ± 0.0848 to 2.870 ± 0.0977 U/mg protein) activities, significantly improved fecal lipid levels, and lowered the epididymal fat index in hyperlipidemic mice compared with the HFD control mice (p < 0.05). In vitro, the high antioxidant capacity of BCA was determined by the FRAP assay, ABTS^•+ scavenging method, and an ROS assay. In RAW 264.7 macrophages, a dose of 10 μM BCA significantly increased the cholesterol efflux by 18.7% compared with the control cells. Moreover, molecular docking of BCA on cholesterol ester transfer protein (CETP) (Asn24 and Thr27 at the N-terminal; Ala274 and Phe270 at the C-terminal) gave new insights into the role of BCA in preventing cholesterol ester transport.

Lipid accumulation product and metabolic syndrome: a population-based study in northern Iran, Amol

PURPOSE

Lipid accumulation product (LAP) demonstrated a strong predictive accuracy for metabolic syndrome (MetS) in previous studies. This study was conducted to determine the predictive performance of LAP compared to obesity indexes. Moreover, the optimal cutoff point of LAP based on the study population waist circumference threshold was estimated in both men and women.

METHODS

5797 subjects with an average age of 44.77 ± 16.77 years for men and 43.78 ± 15.43 years for women were included in the present study. The ROC analysis was performed to assess the predictive accuracy of LAP in the diagnosis of MetS. The optimal cutoff point of LAP was determined according to maximal Youden index in both men and women.

RESULTS

The optimal cutoff points determined for LAP were 49.71 (sensitivity = 85.2 %, specificity = 82.3 %) for women and 39.89 (sensitivity = 86 %, specificity = 79.6 %) for men. Based on the assigned cutoff points, the prevalence of high LAP was obtained 44.1 % in men and 45.1 % in women. LAP also showed a significantly higher predictive performance for MetS compared to obesity measures and also TG.

CONCLUSION

LAP has a strong and reliable diagnostic accuracy for MetS in Iranian population in the north of Iran. LAP showed a better predictability than other obesity indexes assessed in the present study.

Lipid Accumulation Product and Hypertension Related to Stroke: a 9.2-Year Prospective Study Among Mongolians in China

AIMS

We aimed to assess the relationship between lipid accumulation product (LAP) and stroke incidence and whether increased LAP would further enlarge the risk of stroke in participants with hypertension in an Inner Mongolian population of China.

METHODS

Based on the baseline survey conducted in 2002-2003, a prospective cohort study was conducted among 2547 Mongolian people from Inner Mongolia, China. LAP was calculated by waist circumference (WC) and triglyceride (TG) concentration for men and women, respectively. Cox proportional hazards models and receiver operating characteristic (ROC) curves were used to evaluate the associations between LAP, hypertension, and stroke incidence.

RESULTS

During the follow-up period, a total of 121 stroke events were observed. Participants with higher LAP were associated with higher risk of stroke [adjusted hazard ratio (HR), 1.67; 95% confidence interval (CI), 1.08-2.58] than the participants in the lower LAP group. However, no significant dose-response relationship was detected between LAP levels and risk of stroke (P-trend=0.103). The Kaplan-Meier curves showed that hypertensives with high LAP had highest cumulative stroke incidence rate (log-rank P ＜0.001). The multivariate-adjusted HRs (95% CIs) of stroke for normotensives with high LAP, hypertensives with low LAP, and hypertensives with high LAP were 1.80 (0.84-3.89), 2.94 (1.51-5.74), and 4.23 (2.15-8.34), respectively, compared with normotensives with low LAP.

CONCLUSIONS

The present study showed that high LAP was associated with an increased risk of future stroke, and hypertensives with high LAP had the highest risk of stroke among Inner Mongolians. These findings indicate that LAP and hypertension may be valuable to predict and prevent stroke incidence.