Visceral Adiposity Index (VAI) in Children and Adolescents with Obesity: No Association with Daily Energy Intake but Promising Tool to Identify Metabolic Syndrome (MetS)

Comparison of Incidence of Metabolic Syndrome and Five Obesity- and Lipid-Linked Indicators for Predicting Metabolic Syndrome Among Normal-Weight and Overweight Adults

Purpose

Metabolic syndrome (MetS) is an increasingly prevalent issue in China's public health landscape. Few studies have investigated the metabolic syndrome (MetS) in overweight people. We proposed to analyze and contrast the occurrence of MetS in normal-weight and overweight individuals and identify potential indicators for forecasting MetS in adults in Zhejiang Province.

Methods

This cohort study included 359 adults aged 40-65 years and followed up for five years in Zhejiang Province. The study assessed the predictive capabilities of five indicators linked to obesity and lipid levels, namely body mass index (BMI), waist-to-height ratio (WHtR), triglyceride-glucose index (TyGi), and their combined indices (TyG-BMI, TyG-WHtR). The evaluation was done employing the area under the Receiver Operating Characteristic (ROC) Curve (AUC). DeLong test was applied to compare area under different ROC curves.We evaluated the relationships between five variables and MetS using multivariate logistic regression.

Results

In normal-weight individuals, the five-year cumulative incidence of MetS was 21.85%, but in overweight people, it was 60.33%. After adjusting for confounding factors, BMI, WHtR, TyGi, TyG-BMI, and TyG-WHtR were independently linked to MetS in normal-weight individuals, while BMI, TyGi, TyG-BMI, and TyG-WHtR were independently linked to MetS in overweight individuals. In normal-weight individuals, the WHtR (AUC=0.738 and optimal threshold value =0.469) and TyG-WHtR (AUC=0.731 and optimal threshold value =4.121) had the larger AUC, which was significantly greater than that of the different three indicators. The TyG-BMI (AUC=0.769 and optimal threshold value = 211.099) was the best predictor of MetS in overweight individuals.

Conclusion

The five-year cumulative incidence of MetS in overweight people was approximately triple that of normal-weight people in Zhejiang Province. In the overweight population, the TyG-BMI performed better than the other indices in predicting MetS. WHtR and TyG-WHtR outperformed BMI, TyGi, and TyG-BMI in anticipating MetS in a normal-weight population.

Selenoprotein-p and insulin resistance in children and adolescents with obesity

BACKGROUND

Insulin resistance and obesity present significant challenges in pediatric populations. Selenoprotein P1 (SEPP1) serves as a biomarker for assessing selenium levels in the body. While its association with metabolic syndrome is established in adults, its relevance in children remains underexplored.

AIM

To ascertain SEPP1 blood levels in children and adolescents diagnosed with obesity and to assess its correlation with insulin resistance and adiposity indices.

METHODS

170 children participated in this study, including 85 diagnosed with obesity and an equal number of healthy counterparts matched for age and sex. Each participant underwent a comprehensive medical evaluation, encompassing a detailed medical history, clinical examination, and anthropometric measurements like waist circumference and waist-to-height ratio. Furthermore, routine blood tests were conducted, including serum SEPP1, visceral adiposity index (VAI), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) level.

RESULTS

Our findings revealed significantly lower serum SEPP1 levels in children with obesity compared to their healthy peers. Moreover, notable negative correlations were observed between serum SEPP1 levels and body mass index, VAI, and HOMA-IR.

CONCLUSION

The study suggests that SEPP1 could serve as a valuable predictor for insulin resistance among children and adolescents diagnosed with obesity. This highlights the potential utility of SEPP1 in pediatric metabolic health assessment and warrants further investigation.

Association between cardiometabolic index and testosterone levels in adult men: NHANES 2011-2016

OBJECTIVE

Exploring the relationship between the cardiometabolic index (CMI) and serum testosterone levels as well as testosterone deficiency in American adult males. Additionally, comparing the diagnostic value of the CMI with several common obesity and metabolism indices for identifying testosterone deficiency.

METHODS

This cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. Serum testosterone levels and testosterone deficiency were used as dependent variables, with the cardiometabolic index as the independent variable. Multivariable regression was used to assess the relationship between the independent and dependent variables, while subgroup analyses were performed to ensure the stability of the results. Smooth curve fitting was utilized to evaluate the nonlinear relationship between the CMI and testosterone levels. Receiver operating characteristic curves (ROC) were plotted for several obesity and metabolism prediction indices and the area under the curve was calculated to compare the specificity and sensitivity of each diagnostic index in the diagnosis of testosterone deficiency.

RESULTS

Among 3541 adult male participants, CMI is negatively associated with serum testosterone levels and positively associated with testosterone deficiency. In the fully adjusted model, for every unit increase in CMI, serum testosterone decreased by 14.89 ng/dl. Comparing the highest quartile to the lowest quartile of CMI, each unit increase in CMI, serum testosterone decreased by 98.58 ng/dl. Furthermore, each unit increase in CMI was associated with a 16% increase in incidence of testosterone deficiency. By plotting the ROC curves, we found that the AUCs for Lipid Accumulation Product (LAP), Body Mass Index (BMI), Weight Adjusted Waist Index (WWI), CMI, Visceral Adiposity Index (VAI) and Triglyceride glucose index (TyG) were 0.73, 0.72, 0.71, 0.69, 0.66, and 0.66 respectively.

CONCLUSION

Elevated levels of CMI are associated with lower testosterone levels and an increased risk of testosterone deficiency. The predictive value of the LAP was superior to that of CMI, while the predictive value of CMI was higher than VAI and TyG.

Association between visceral adiposity index and incidence of diabetic kidney disease in adults with diabetes in the United States

Visceral adiposity index (VAI) is a reliable indicator of visceral adiposity. However, no stu-dies have evaluated the association between VAI and DKD in US adults with diabetes. Theref-ore, this study aimed to explore the relationship between them and whether VAI is a good pr-edictor of DKD in US adults with diabetes. Our cross-sectional study included 2508 participan-ts with diabetes who were eligible for the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Univariate and multivariate logistic regression were used to an-alyze the association between VAI level and DKD. Three models were used to control for pot-ential confounding factors, and subgroup analysis was performed for further verification. A tot-al of 2508 diabetic patients were enrolled, of whom 945 (37.68%) were diagnosed with DKD. Overall, the VAI was 3.36 ± 0.18 in the DKD group and 2.76 ± 0.11 in the control group. VAI was positively correlated with DKD (OR = 1.050, 95% CI 1.049, 1.050) after fully adjusting for co-nfounding factors. Compared with participants in the lowest tertile of VAI, participants in the highest tertile of VAI had a significantly increased risk of DKD by 35.9% (OR = 1.359, 95% CI 1.355, 1.362). Through subgroup analysis, we found that VAI was positively correlated with the occurrence of DKD in all age subgroups, male(OR = 1.043, 95% CI 1.010, 1.080), participants wit-hout cardiovascular disease(OR = 1.038, 95% CI 1.011, 1.069), hypertension (OR = 1.054, 95% CI 1.021, 1.090), unmarried participants (OR = 1.153, 95% CI 1.036, 1.294), PIR < 1.30(OR = 1.049, 95% CI 1.010, 1.094), PIR ≧ 3 (OR = 1.085, 95% CI 1.021, 1.160), BMI ≧ 30 kg/m2 (OR = 1.050, 95% CI 1.016, 1.091), former smokers (OR = 1.060, 95% CI 1.011, 1.117), never exercised (OR = 1.033, 95% CI 1.004, 1.067), non-Hispanic white population (OR = 1.055, 95% CI 1.010, 1.106) and non-Hipanic black population (OR = 1.129, 95% CI 1.033, 1.258). Our results suggest that elevated VAI levels are closely associated with the development of DKD in diabetic patients. VAI may be a simpl-e and cost-effective index to predict the occurrence of DKD. This needs to be verified in furt-her prospective investigations.

Relationship of anthropometrics and blood pressure to identify people at risk of hypertension and obesity-related conditions in Nigerian rural areas

The prevalence of obesity and hypertension is increasing, particularly in the urban areas. However, there is limited research on the relationship between obesity and hypertension in the rural areas of southeastern Nigeria. The present study aimed to investigate the association between anthropometric parameters and adiposity indicators and the risk of hypertension with obesity-related conditions, based on a descriptive study of people living in the southeastern rural areas of Nigeria. The cluster sampling procedure randomly recruited study participants. Finally, 200 participants (100 male and 100 female) aged 18 to 25 years were included in the study. A simplified correlation analysis was used to derive the adjusted indicators in relation to age and sex. This study found that females generally had a higher body mass index (BMI), waist circumference (WC), and Z-score, whereas systolic blood pressure (SBP) was higher in men. A high correlation was found between the body shape index (ABSI) and BMI (r = -.529, P < .001), WC (r = .399, P < .001) and Z-score (r = .982, P < .001) in male participants. In females, there was a high correlation between ABSI and BMI, blood pressure (BP), and Z score in female participants (r = -.481, P < .000; r = -.267, P = .007; r = .941, P < .000). In male participants, BMI was correlated with diastolic blood pressure (DBP; r = .236, P = .018), SBP (r = .282, P = .005), Z score (r = -.539, P < .000), and WC (r = .541, P < .001). This study highlights the importance of considering a range of anthropometric measurements and health parameters when assessing health risks and identifying potential interventions. In addition, the body shape index may be a particularly useful tool for predicting health risks in both men and women. In contrast, correlations between various health parameters can provide insights into the underlying mechanisms and risk factors.

Assessing the impact of concurrent high-fructose and high-saturated fat diets on pediatric metabolic syndrome: A review

High-saturated fat (HF) or high-fructose (HFr) consumption in children predispose them to metabolic syndrome (MetS). In rodent models of MetS, diets containing individually HF or HFr lead to a variable degree of MetS. Nevertheless, simultaneous intake of HF plus HFr have synergistic effects, worsening MetS outcomes. In children, the effects of HF or HFr intake usually have been addressed individually. Therefore, we have reviewed the outcomes of HF or HFr diets in children, and we compare them with the effects reported in rodents. In humans, HFr intake causes increased lipogenesis, hypertriglyceridemia, obesity and insulin resistance. On the other hand, HF diets promote low grade-inflammation, obesity, insulin resistance. Despite the deleterious effects of simultaneous HF plus HFr intake on MetS development in rodents, there is little information about the combined effects of HF plus HFr intake in children. The aim of this review is to warn about this issue, as individually addressing the effects produced by HF or HFr may underestimate the severity of the outcomes of Western diet intake in the pediatric population. We consider that this is an alarming issue that needs to be assessed, as the simultaneous intake of HF plus HFr is common on fast food menus.

Cardiometabolic Risk Assessment in a Cohort of Children and Adolescents Diagnosed with Hyperinsulinemia

BACKGROUND

Individuals with hyperinsulinemia may initially not meet any diagnostic criteria for metabolic syndrome, though displaying a higher risk of cardiovascular complications combined with obesity, diabetes, and hypertension.

AIM

The main objective of our study was to assess the diagnostic accuracy of various cardiovascular risk indices in hyperinsulinemic children and adolescents; a secondary objective was to estimate the optimal cut-offs of these indices.

PATIENTS AND METHODS

This retrospective single-center study was conducted on 139 patients aged 12.1 ± 2.9 years, managed for hyperinsulinism.

RESULTS

We found statistically significant differences in homeostasis model assessment of insulin resistance index (HOMA-IR), triglyceride glucose index (TyG), TyG-body mass index, visceral adiposity index, lipid accumulation product index, fatty liver index, and hepatic steatosis index. At the linear logistic regression assessment, we found that insulin growth factor-1 (IGF-1), HOMA-IR, and ALT/AST ratio were independently associated with confirmed hyperinsulinism. At the multivariate analysis, IGF-1 levels over 203 ng/mL and HOMA-IR higher than 6.2 were respectively associated with a 9- and 18-times higher odds ratio for hyperinsulinism. The other investigated parameters were not significantly related to hyperinsulinism, and could not predict either the presence of hyperinsulinemia or a subsequent cardiovascular risk in our patients.

CONCLUSION

Commonly used indices of cardiovascular risk in adults cannot be considered accurate in confirming hyperinsulinism in children, with the exception of HOMA-IR. Further studies are needed to verify the usefulness of specific cardiovascular risk indices in hyperinsulinemic children and adolescents.

Evaluating eight indicators for identifying metabolic syndrome in Chinese and American adolescents

BACKGROUND

Early intervention and diagnosis of Metabolic Syndrome (MetS) are crucial for preventing adult cardiovascular disease. However, the optimal indicator for identifying MetS in adolescent remains controversial.

METHODS

In total,1408 Chinese adolescents and 3550 American adolescents aged 12-17 years were included. MetS was defined according to the modified version for adolescents based on Adult Treatment Panel III (NCEP-ATP III) criteria. Areas under the curve (AUC) and corresponding 95% confidence interval (95% CI) of 8 anthropometric/metabolic indexes, such as waist circumference (WC), body mass index (BMI), a body shape index (ABSI), waist triglyceride index (WTI), were calculated to illustrate their ability to differentiate MetS. Sensitivity analysis using the other MetS criteria was performed.

RESULTS

Under the modified NCEP-ATP III criteria, WTI had the best discriminating ability in overall adolescents, with AUC of 0.922 (95% CI: 0.900-0.945) in Chinese and 0.959 (95% CI: 0.949-0.969) in American. In contrast, ABSI had the lowest AUCs. Results of sensitivity analysis were generally consistent for the whole Chinese and American population, with the AUC for WC being the highest under some criteria, but it was not statistically different from that of WTI.

CONCLUSIONS

WTI had relatively high discriminatory power for MetS detection in Chinese and American adolescents, but the performance of ABSI was poor.

IMPACT

While many studies have compared the discriminatory power of some anthropometric indicators for MetS, there are few focused on pediatrics. The current study is the first to compare the discriminating ability of anthropometric/metabolic indicators (WC, BMI, TMI, ABSI, WHtR, VAI, WTI, and TyG) for MetS in adolescents. WTI remains the optimal indicator in screening for MetS in adolescents. WC was also a simple and reliable indicator when screening for MetS in adolescents, but the performance of ABSI was poor. This study provides a theoretical basis for the early identification of MetS in adolescents by adopting effective indicators.

Association between serum vitamin A and body mass index in adolescents from NHANES 1999 to 2006

Vitamin A plays a pivotal role in health, particularly in regulating fat metabolism. Despite its significance, research into the direct relationship between vitamin A levels and obesity, especially among adolescents, is sparse. This study aims to explore this association within the adolescent population in the United States. This cross-sectional study analyzed the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2006, with 8218 participants. The levels of vitamin A in the serum were determined based on utilizing high-performance liquid chromatography with photodiode array detection. The relationship between serum vitamin A concentrations and body mass index (BMI) was evaluated using weighted multiple linear regression models, incorporating subgroup analyses by sex and race/ethnicity to provide nuanced insights. A positive correlation was observed between serum vitamin A levels and BMI, with BMI increasing progressively across vitamin A quartiles (P < 0.001). Using the lowest quartile of serum vitamin A as a reference, the BMI of the highest quartile of serum vitamin A was 1.236 times higher (95% CI 0.888, 1.585). Subgroup analyses revealed that this positive association persisted across different genders and racial/ethnic groups (P < 0.001). Notably, smooth curve fitting and saturation threshold analysis unveiled an inverted U-shaped relationship between serum vitamin A and BMI among female adolescents, non-Hispanic Whites, Mexican Americans, and other races/ethnicities groups. Our study substantiates the association between serum vitamin A levels and the risk of obesity/overweight status in adolescents. The findings suggest the potential serum vitamin A is an early biomarker for identifying obesity risk, although further studies are needed to determine to clarify its role as a contributing factor to obesity. This study contributes to the understanding of nutritional influences on adolescent obesity, highlighting the need for targeted interventions based on serum biomarkers.

Association between birth weight and insulin resistance in US adolescents: A retrospective cohort study exploring the role of concurrent body mass index

BACKGROUND AND AIMS

This study aimed to investigate the association between birth weight (BW) and abnormal HOMA-IR in US adolescents aged 12-15 years. The role of concurrent body mass index (BMI) in adolescence was also examined.

METHODS AND RESULTS

This retrospective cohort study included 3429 participants from NHANES with data in 1999-2020. HOMA-IR ≥2.3 was considered abnormal. Participants were classified as low (LBW; <2.5 kg), normal (NBW; 2.5-4.0 kg), or high (HBW; >4.0 kg) BW. Logistic regression was used to explore the association between BW and HOMA-IR. Mediation analysis was used to examine whether BMI z-score in adolescence mediated the association between BW and HOMA-IR. Compared with those in NBW, the odds ratios (95 % CI) of abnormal HOMA-IR in LBW and HBW groups were 1.26 (0.99-1.60), and 0.62 (0.47-0.83) respectively. The association between BW and abnormal HOMA-IR was consistent in all subgroups with no significant interactions. Mediation analysis showed that BW is associated with lower risk of HOMA-IR directly, but with higher risk indirectly via BMI in adolescence.

CONCLUSION

There was a negative linear relationship between BW and the prevalence of abnormal HOMA-IR in adolescents aged 12-15 independent of concurrent BMI. Children who were born with LBW but had high BMI in adolescence were of particularly higher risk of insulin resistance.

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

BACKGROUND AND AIMS

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

METHODS AND RESULTS

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

CONCLUSIONS

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

The pathophysiology of visceral adipose tissues in cardiometabolic diseases

Central pattern of fat distribution, especially fat accumulation within the intraabdominal cavity increases risks for cardiometabolic diseases. Portal hypothesis combined with a pathological remodeling in visceral fat is considered the major etiological factor explaining the independent contribution of visceral obesity to cardiometabolic diseases. Excessive remodeling in visceral fat during development of obesity leads to dysfunctions in the depot, characterized by hypertrophy and death of adipocytes, hypoxia, inflammation, and fibrosis. Dysfunctional visceral fat secretes elevated levels of fatty acids, glycerol, and proinflammatory and profibrotic cytokines into the portal vein directly impacting the liver, the central regulator of systemic metabolism. These metabolic and endocrine products induce ectopic fat accumulation, insulin resistance, inflammation, and fibrosis in the liver, which in turn causes or exacerbates systemic metabolic derangements. Elucidation of underlying mechanisms that lead to the pathological remodeling and higher degree of dysfunctions in visceral adipose tissue is therefore, critical for the development of therapeutics to prevent deleterious sequelae in obesity. We review depot differences in metabolic and endocrine properties and expendabilities as well as underlying mechanisms that contribute to the pathophysiological aspects of visceral adiposity in cardiometabolic diseases. We also discuss impacts of different weight loss interventions on visceral adiposity and cardiometabolic diseases.

Sex differences in cardiometabolic risk factors and in response to lifestyle intervention in prepubertal and pubertal subjects with obesity

Objectives

Childhood obesity is a growing health problem and requires a tailored treatment. This study explored the sex differences in cardiovascular risk factors in children/adolescents with obesity and in response to a weight loss intervention.

Methods

Five hundred and thirty-three children/adolescents with obesity and their parents underwent to a 3-months lifestyle intervention program. Tanner criteria were used to assess the pubertal stage. Before and after 3 months, anthropometric measurements, blood pressure (BP), and biochemical measurements were assessed.

Results

Four hundred and forty five participants completed the treatment (age 12.4 ± 2.7 years, males 45.8%, prepubertal 29.2%, BMI z score 2.3 ± 0.2). In comparison to boys, prepubertal girls had higher values of BMI z score (2.4 ± 02 vs. 2.3 ± 0.2, p < 0.05), waist circumference z score (2.2 ± 0.3 vs. 2.0 ± 0.3, p < 0.05), HOMA-IR [2.9 (2.1-4.9) vs. 2.3(1.5-3.6), p < 0.01], prevalence of hypertransaminasemia (41.3% vs. 17.7%, p < 0.05) and lower levels of HDL cholesterol (46.2 ± 9.8 vs. 51.2 ± 10.5 mg/dl, p < 0.05). In the pubertal stage, boys had worse cardiometabolic risk profile than girls, including unfavourable measure of systolic BP (z score: 0.6 ± 1.0 vs. 0.3 ± 1.0, p < 0.01), fasting glucose (87.2 ± 6.1 vs. 84.8 ± 7.7 mg/dl, p < 0.01), ALT (26.9 ± 21.5 vs. 20.2 ± 10.6 U/L, p < 0.001) and uric acid (6.1 ± 1.9 vs. 5.0 ± 1.0 mg/dl, p < 0.001). After the lifestyle intervention, changes in BMI z score (p < 0.05) were higher in pubertal boys than pubertal girls. The systolic blood pressure decrease was greater in pubertal boys than in their female counterpart (Δ systolic BP: -7.2 mmHg in boys vs. -3.6 mmHg in girls, p < 0.05; Δ systolic BP z score: -0.6 in boys vs. -0.3 in girls, p < 0.05). LDL cholesterol showed an improvement only in boys, and ALT in the whole group.

Conclusion

Our study showed that a short-term lifestyle intervention is more effective in reducing BMI z score and cardiovascular risk factors in pubertal boys than in their female counterparts. Further investigation is needed to deepen this gender difference, especially to develop a tailor-made intervention.

Relationship between visceral adiposity index and glycemic and metabolic control in children and adolescents with type 1 diabetes mellitus

BACKGROUND

Visceral Adiposity Index (VAI) is a gender-specific mathematical model based on BMI, waist circumference (WC) and lipid parameters. No study has yet examined the relationship between this index and the glycemic and metabolic parameters in children and adolescents with Type 1 Diabetes Mellitus (DM). The current study aims at examining the relationship between glycemic and metabolic control and VAI in children and adolescents with Type 1 DM.

METHODS

A total of 150 children and adolescents aged 6-18 years with Type 1 DM were included in this study. Anthropometric, glycemic and metabolic parameters were examined. VAI was calculated using gender-specific formulas. Statistical analysis was done by SPSS version 23.

RESULTS

The average age of the participants was 12.2 ± 3.1 years (females 53.0%). The females had higher rates of VAI, microalbuminuria and hypertension than males. Participants of both gender with higher VAI quartiles had higher anthropometric measurements, insulin usage, low-density lipoprotein cholesterol (LDL-C), triglycerides and urine microalbumin and had poor glycemic control. Sex adjusted correlation analysis showed that VAI is negatively correlated with estimated glucose disposal rate (eGDR), and positively correlated with insulin dose, LDL-C, triglycerides, glycosylated hemoglobin (HbA1c) and microalbuminuria.

CONCLUSION

The present paper is the first study examining the relationship between Type 1 DM and VAI. Higher VAI values in children and adolescents with type 1 DM may adversely affect glycemic and metabolic control. VAI can be a useful and new method in evaluating glycemic and metabolic control in children and adolescents with Type 1 DM.

Novel Predictor of the AF Development in Patients with OSAS: Importance of Visceral Adipose Index

Objective

Obstructive sleep apnea syndrome (OSAS) is a sleep disorder whose frequency is increasing daily due to modern lifestyle. Patients with atrial fibrillation (AF), which has the same predisposing factors, frequently visit the outpatient clinic with complaints of palpitation. Existing symptoms are often associated with the course of OSAS, and the development of AF, a disease with high morbidity and mortality, cannot be detected. In our study, we investigated the relationship between the visceral adiposity index (VAI) and AF development in these patients.

Methods

We retrospectively analyzed 207 patients with OSAS who visited the cardiology outpatient clinic. The data of 44 patients with AF and 163 patients without AF were compared.

Results

Demographic characteristics and clinical risk factors were similar between the groups (p>0.05). VAI, apnea-hypopnea index, and inflammatory markers were higher in the AF group, and these risk factors were significant in the multivariate analysis (p<0.05).

Conclusions

Our study is important in terms of showing VAI as one of the most important predictors of AF, which has an impact on mortality and morbidity in patients with OSAS, whose frequency is increasing daily. Further prospective studies are required to confirm our observations and determine their clinical applicability.

Impaired HDL-associated enzymes and proteins in children and adolescents with weight disorders and their association with novel cardiometabolic indexes

BACKGROUND AND AIMS

Overweight/obesity (OW/OB) is associated with modifications in lipoprotein (Lp)-associated enzymes and proteins, such as cholesteryl ester transfer protein (CETP), Lp-associated phospholipase A2 (LpPLA2) and paraoxonase (PON)1. No evidence is available regarding underweight (UW). The following indexes have been proposed to better assess atherogenic risk related to weight alterations: triglycerides-glucose index (TyG), visceral adiposity index (VAI) and height-corrected lipid accumulation product (HLAP).

AIM

To analyze the presence of alterations in Lp-associated enzymes and proteins in children and adolescents with UW and OW/OB and their relation to novel cardiometabolic indexes.

METHODS AND RESULTS

Thirty male children and adolescents with UW, 66 with normal weight (NW) and 30 with OW/OB were included. Anthropometric parameters, glucose, Lp profile and the activities of CETP, LpPLA2 and PON1 were evaluated. Body mass index (BMI)-z, TyG, VAI and HLAP were calculated. UW and NW showed lower CETP activity than OW/OB (Mean ± SD) (218 ± 38vs.224 ± 26vs.237 ± 26%/mL.h; p < 0.05). UW and OW/OB showed lower PON1 activity than NW (318 ± 170vs.409 ± 200vs.310 ± 184 nmol/mL.min; p < 0.05). TyG was higher in OW/OB than UW (p < 0.01), whilst both HLAP (p < 0.05) and VAI (p < 0.01) followed a linear trend across weight categories. After adjusting for age and BMI-z, TyG was an independent predictor of CETP (r2 = 0.25, β = -0.22, p < 0.01) and LpPLA2 (r2 = 0.21,β = -0.21,p < 0.05), while VAI (r2 = 0.21,β = -0.32,p < 0.01) and HLAP (r2 = 0.20,β = -0.31,p < 0.01) of CETP.

CONCLUSIONS

Both UW and OW/OB showed impaired antioxidant PON1 activity. Moreover, TyG, VAI and HLAP were all capable of predicting alterations in crucial modulators of Lp metabolism and vascular inflammation in children and adolescents with varying degrees of alterations in body weight.

Criteria in the Diagnosis of Metabolic Syndrome in Children: A Scoping Review

Currently, there is no consensus on the criteria for identifying metabolic syndrome in children, as observed in the diversity of research developed. For this reason, a scoping review was developed in this work, in order to compare the criteria for the diagnosis of metabolic syndrome (MetS) applied in children, described in observational, descriptive cross-sectional studies. The databases PubMed, Scopus, Web of Science and the search engine Google Scholar were used. The search terms "metabolic syndrome", "cardiometabolic syndrome", "child", "children" and "childhood" were considered, as well as the names of organizations or authors proposing identification criteria for MetS to establish search relationships using the Boolean connectors "AND" and "OR". Likewise, two reviewers carried out the evaluation and selection of articles, of which 26 articles were included in which children aged 6 to 12 participated. It was found that the most commonly used criteria for identifying MetS since 2015 are those of Cook et al, IDF, NCEP ATPIII, and De Ferranti et al, in that order. Specific criteria, such as those proposed by Cook et al, are being chosen to enhance the accuracy of identifying MetS in children. The most common risk factors in children with MetS are abdominal circumference and BMI, followed by triglycerides, HDL, blood pressure, and blood glucose. The prevalence of MetS in children varies according to the criteria used, being higher with De Ferranti et al.

The association between outdoor air pollution and body mass index, central obesity, and visceral adiposity index among middle-aged and elderly adults: a nationwide study in China

Background

Previous animal studies have suggested that air pollution (AP) exposure may be a potential risk factor for obesity; however, there is limited epidemiological evidence available to describe the association of obesity with AP exposure.

Methods

A retrospective cross-sectional study was conducted on 11,766 participants across mainland China in 2015. Obesity was assessed using body mass index (BMI), waist circumference (WC), and visceral adiposity index (VAI). The space-time extremely randomized tree (STET) model was used to estimate the concentration of air pollutants, including SO2, NO2, O3, PM1, PM2.5, and PM10, matched to participants' residential addresses. Logistic regression models were employed to estimate the associations of obesity with outdoor AP exposure. Further stratified analysis was conducted to evaluate whether sociodemographics or lifestyles modified the effects.

Results

Increased AP exposure was statistically associated with increased odds of obesity. The odds ratio (ORs) and 95% confidence interval (CI) of BMI-defined obesity were 1.21 (1.17, 1.26) for SO2, 1.33 (1.26, 1.40) for NO2, 1.15 (1.10, 1.21) for O3, 1.38 (1.29, 1.48) for PM1, 1.19 (1.15, 1.22) for PM2.5, and 1.11 (1.09, 1.13) for PM10 per 10 μg/m3 increase in concentration. Similar results were found for central obesity. Stratified analyses suggested that elderly participants experienced more adverse effects from all 6 air pollutants than middle-aged participants. Furthermore, notable multiplicative interactions were found between O3 exposure and females as well as second-hand smokers in BMI-defined obesity.

Conclusions

This study suggested that outdoor AP exposure had a significant association with the risk of obesity in the middle-aged and elderly Chinese population. Elderly individuals and women may be more vulnerable to AP exposure.

Bone mineral density saturation as influenced by the visceral adiposity index in adults older than 20 years: a population-based study

OBJECTIVE

The goal of this research was to determine whether or not there is a saturation effect and whether or not the visceral adiposity index (VAI) correlates with bone mineral density (BMD) in adult Americans.

METHODS

This study used multivariate logistic regression models to examine the association between VAI and total femur BMD, drawing on the most up-to-date data from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. Saturation levels and non-linear connections were calculated using a smooth curve-fitting algorithm and an investigation of saturation effects. Subgroup analyses and interaction tests were also conducted.

RESULTS

This study ultimately recruited 6257 individuals aged 20 years or older. According to multivariate regression analysis, those with high VAI scores exhibited higher total femur BMD. Total femur BMD was greater in the highest VAI quartile (Q4: 0.060 g/cm2) after adjustment than in the lowest VAI quartile (Q1) (P < 0.05). After controlling for variables, subgroup analysis failed to reveal any significant interaction effects. Furthermore, the study determined that VAI and BMD exhibited a specific saturation effect through the investigation of the saturation effect and the fitting of smooth curves. Saturation effect investigation of total femur BMD using VAI revealed a saturation value of 3.3.

CONCLUSION

The present study uncovered a non-linear relationship between VAI and total femur BMD, which exhibited a saturation effect.

Connections between serum Trimethylamine N-Oxide (TMAO), a gut-derived metabolite, and vascular biomarkers evaluating arterial stiffness and subclinical atherosclerosis in children with obesity

Introduction

Childhood obesity leads to early subclinical atherosclerosis and arterial stiffness. Studying biomarkers like trimethylamine N-oxide (TMAO), linked to cardio-metabolic disorders in adults, is crucial to prevent long-term cardiovascular issues.

Methods

The study involved 70 children aged 4 to 18 (50 obese, 20 normal-weight). Clinical examination included BMI, waist measurements, puberty stage, the presence of acanthosis nigricans, and irregular menstrual cycles. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (CIMT), and the arterial stiffness was evaluated through surrogate markers like the pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures. The blood biomarkers included determining the values of TMAO, HOMA-IR, and other usual biomarkers investigating metabolism.

Results

The study detected significantly elevated levels of TMAO in obese children compared to controls. TMAO presented positive correlations to BMI, waist circumference and waist-to-height ratio and was also observed as an independent predictor of all three parameters. Significant correlations were observed between TMAO and vascular markers such as CIMT, PWV, and peripheral BP levels. TMAO independently predicts CIMT, PWV, peripheral BP, and central SBP levels, even after adding BMI, waist circumference, waist-to-height ratio, puberty development and age in the regression model. Obese children with high HOMA-IR presented a greater weight excess and significantly higher vascular markers, but TMAO levels did not differ significantly from the obese with HOMA-IR

Conclusion

Our study provides compelling evidence supporting the link between serum TMAO, obesity, and vascular damage in children. These findings highlight the importance of further research to unravel the underlying mechanisms of this connection.

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Key Words

• TMAO
• arterial stiffness
• atherosclerosis
• cardiovascular risk
• carotid intima-media thickness
• childhood obesity
• high blood pressure
• pulse wave velocity

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MESH Headings

• Adult
• Female
• Humans
• Child
• Pediatric Obesity/complications
• Carotid Intima-Media Thickness
• Vascular Stiffness/physiology
• Pulse Wave Analysis
• Acanthosis Nigricans
• Atherosclerosis/diagnosis
• Atherosclerosis/etiology
• Biomarkers

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Grants Collapse

Affiliation(s)

Monica Simina Mihuta Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Corina Paul Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Andreea Borlea Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Cristina Mihaela Roi Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Denisa Pescari Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Oana-Alexandra Velea-Barta 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Ioana Mozos Department of Functional Sciences—Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Dana Stoian Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania

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The association between visceral adiposity index and chronic kidney disease in the elderly: A cross-sectional analysis of NHANES 2011-2018

Visceral adiposity index (VAI) is a new metric for evaluating visceral adiposity dysfunction. The aim of the present study was to explore the association between VAI and incident chronic kidney disease (CKD) in the American elderly population. We included 6085 participants aged 60 years or older with available data on renal function and VAI from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 and divided them into four groups according to the VAI quartiles. VAI values were ln-transformed to reduce skewness. We conducted multivariable logistic regression analyses and spline smoothing plot analyses to evaluate the association between VAI and CKD. After fully adjusting for confounding factors, higher lnVAI was associated with a higher risk of CKD (OR, 1.23; 95 %CI, 1.02, 1.48). Compared to the Q1 group (VAI < 1.1), The third and fourth VAI quartiles were associated with a higher prevalence of CKD (Q3: VAI, 1.8-3.0; Q4: VAI > 3.0). The adjusted ORs (95% CI) in Q3 and Q4 were 1.74 (1.24, 2.42) and 1.59 (1.08, 2.33). Adjusted smoothed plots suggested a nonlinear relationship between lnVAI and CKD. The development of CKD increased with increasing VAI among participants with a lnVAI between -0.6 and 1.6 (VAI: 0.5-5.0). In conclusion, VAI is significantly associated with the risk of CKD in the US elderly population aged 60 years or older.

Changes in Metabolic Health and Sedentary Behavior in Obese Children and Adolescents

Obesity is becoming more common among children and adolescents. As in adults, obesity in the pediatric population is associated with an increased risk of metabolic disorders and diseases. In the related literature, little attention has been devoted to evaluating how metabolic health and sedentary behavior change in the obese pediatric population. Therefore, this study aimed to assess changes in metabolic health and sedentary behavior in obese children aged 7-12 and adolescents aged 13-17. For this single-center hospital-based prospective observational study, we included 202 Polish children and adolescents aged 7-17 years. We performed blood pressure measurements and collected blood samples to assess metabolic health markers. Based on the performed measurements, we also calculated additional indexes and ratios: BMI, WHtR, ABSI, VAI, and HOMA-IR. The analysis of the results showed clear and significant differences between the study groups. The older boys and girls were identified with higher values of anthropometric ratios, blood pressure, time spent sitting, and lower HDL cholesterol values (p < 0.05). The analysis also revealed a strong-to-moderate correlation between age and anthropometric ratios, blood pressure, HDL cholesterol, and sitting time (p < 0.05). Obese children and adolescents included in this study represent poor metabolic health and are at great risk of developing other metabolic diseases such as type 2 diabetes, hypertension, or metabolic syndrome. This risk increases with age; therefore, a number of preventive and therapeutic actions should be taken in overweight and obese children and adolescents to avoid further metabolic complications.

Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children

Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.

Hypertension in a cohort of obese Caucasian children and adolescents and its association with glycometabolic indices: A proposed screening tool

BACKGROUND AND AIM

Hypertension (HTN) is common among obese children and adolescents and increases their cardiovascular risk later in adulthood. The aim of the study was to evaluate the prevalence of HTN identified by office blood pressure (BP) measurement and ambulatory BP monitoring (ABPM) in a cohort of obese children and adolescents and its association with anthropometric and glycometabolic indices.

METHODS AND RESULTS

Seventy consecutive obese Caucasian children and adolescents aged 7-16 years were enrolled. Patients underwent ABPM, echocardiogram and carotid ultrasonography. Sex- and age-adjusted logistic multivariable analysis models were used to assess the association between HOMA-IR, HOMA-β, QUICKI with HTN at ABPM. Receiver Operation Curve (ROC) analysis with Youden J statistics was used to identify the optimal HOMA-IR, HOMA-β and QUICKI cut-off to predict HTN at ABPM. Hypertensive office BP was found in 25.7% of obese patients. ABPM diagnosed HTN in 34.9% of patients: 20.6% of obese patients had masked HTN (MHTN), and 12.7% had white coat HTN (WCH). Hypertensive obese patients (according to ABPM) had higher HOMA-IR and HOMA-β, and a lower QUICKI than normotensive subjects. HOMA-IR, HOMA-β and QUICKI predicted HTN at ABPM in obese patients in age- and sex-adjusted logistic multivariable models. Optimal cut-offs to predict HTN at ABPM in obese patients were: HOMA-IR ≥ 3.30, HOMA-β ≥ 226.7 and QUICKI <0.33, with high sensitivity.

CONCLUSIONS

A sequential testing strategy applying office BP and glycometabolic indices can identify hypertensive obese pediatric patients with high diagnostic accuracy and potentially reducing costs. This strategy needs validation in an external and larger cohort.

Leveraging the future of diagnosis and management of diabetes: From old indexes to new technologies

BACKGROUND

Diabetes is a heterogeneous and multifactorial disease. However, glycemia and glycated hemoglobin have been the focus of diabetes diagnosis and management for the last decades. As diabetes management goes far beyond glucose control, it has become clear that assessment of other biochemical parameters gives a much wider view of the metabolic state of each individual, enabling a precision medicine approach.

METHODS

In this review, we summarize and discuss indexes that have been used in epidemiological studies and in the clinical practice.

RESULTS

Indexes of insulin secretion, sensitivity/resistance and metabolism have been developed and validated over the years to account also with insulin, C-peptide, triglycerides or even anthropometric measures. Nevertheless, each one has their own objective and consequently, advantages and disadvantages for specific cases. Thus, we discuss how new technologies, namely new sensors but also new softwares/applications, can improve the diagnosis and management of diabetes, both for healthcare professionals but also for caretakers and, importantly, to promote the empowerment of people living with diabetes.

CONCLUSIONS

In long-term, the solution for a better diabetes management would be a platform that allows to integrate all sorts of relevant information for the person with diabetes and for the healthcare practitioners, namely glucose, insulin and C-peptide or, in case of need, other parameters/indexes at home, sometimes more than once a day. This solution would allow a better and simpler disease management, more adequate therapeutics thereby improving patients' quality of life and reducing associated costs.

Obesity- and lipid-related indices as a predictor of obesity metabolic syndrome in a national cohort study

Objective

Metabolic syndrome is a common condition among middle-aged and elderly people. Recent studies have reported the association between obesity- and lipid-related indices and metabolic syndrome, but whether those conditions could predict metabolic syndrome is still inconsistent in a few longitudinal studies. In our study, we aimed to predict metabolic syndrome by obesity- and lipid-related indices in middle-aged and elderly Chinese adults.

Method

A national cohort study that consisted of 3,640 adults (≥45 years) was conducted. A total of 13 obesity- and lipid-related indices, including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), conicity index (CI), visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), and triglyceride glucose index (TyG-index) and its correlation index (TyG-BMI, TyG-WC, and TyG-WHtR), were recorded. Metabolic syndrome (MetS) was defined based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III (2005). Participants were categorized into two groups according to the different sex. Binary logistic regression analyses were used to evaluate the associations between the 13 obesity- and lipid-related indices and MetS. Receiver operating characteristic (ROC) curve studies were used to identify the best predictor of MetS.

Results

A total of 13 obesity- and lipid-related indices were independently associated with MetS risk, even after adjustment for age, sex, educational status, marital status, current residence, history of drinking, history of smoking, taking activities, having regular exercises, and chronic diseases. The ROC analysis revealed that the 12 obesity- and lipid-related indices included in the study were able to discriminate MetS [area under the ROC curves (AUC > 0.6, P < 0.05)] and ABSI was not able to discriminate MetS [area under the ROC curves (AUC < 0.6, P > 0.05)]. The AUC of TyG-BMI was the highest in men, and that of CVAI was the highest in women. The cutoff values for men and women were 187.919 and 86.785, respectively. The AUCs of TyG-BMI, CVAI, TyG-WC, LAP, TyG-WHtR, BMI, WC, WHtR, BRI, VAI, TyG index, CI, and ABSI were 0.755, 0.752, 0.749, 0.745, 0.735, 0.732, 0.730, 0.710, 0.710, 0.674, 0.646, 0.622, and 0.537 for men, respectively. The AUCs of CVAI, LAP, TyG-WC, TyG-WHtR, TyG-BMI, WC, WHtR, BRI, BMI, VAI, TyG-index, CI, and ABSI were 0.687, 0.674, 0.674, 0.663, 0.656, 0.654, 0.645, 0.645, 0.638, 0.632, 0.607, 0.596, and 0.543 for women, respectively. The AUC value for WHtR was equal to that for BRI in predicting MetS. The AUC value for LAP was equal to that for TyG-WC in predicting MetS for women.

Conclusion

Among middle-aged and older adults, all obesity- and lipid-related indices, except ABSI, were able to predict MetS. In addition, in men, TyG-BMI is the best indicator to indicate MetS, and in women, CVAI is considered the best hand to indicate MetS. At the same time, TyG-BMI, TyG-WC, and TyG-WHtR performed better than BMI, WC, and WHtR in predicting MetS in both men and women. Therefore, the lipid-related index outperforms the obesity-related index in predicting MetS. In addition to CVAI, LAP showed a good predictive correlation, even more closely than lipid-related factors in predicting MetS in women. It is worth noting that ABSI performed poorly, was not statistically significant in either men or women, and was not predictive of MetS.

Comparison of the ability of HOMA-IR, VAI, and TyG indexes to predict metabolic syndrome in children with obesity: a cross-sectional study

BACKGROUND

The increasing trend in childhood obesity needs to be closely monitored and intervened due to long-term health issues such as metabolic syndrome, cardiovascular diseases, hypertension, and type 2 diabetes. We aimed to determine and compare the cut-off values for the visceral adiposity index (VAI), triglyceride-glucose index (TyG), and HOMA-IR for predicting metabolic syndrome (MetS).

METHODS

This population-based cross-sectional study was conducted in May 2019 in Samsun, Turkey. The study included 169 children with obesity aged 9 and 10 years. After anthropometric and clinical evaluation, fasting blood samples were collected from the children. The areas under the curve of the visceral adiposity index, triglyceride-glucose index, and HOMA-IR were compared by receiver-operating-characteristic (ROC) analysis in predicting the MetS.

RESULTS

The total prevalence of MetS was 21.3% in children with obesity, and it was two times higher in girls than in boys. The mean values of TyG and VAI were significantly different in those who have and have not MetS in both genders. However, the HOMA-IR index was higher only in girls with MetS and did not differ in boys by having MetS. The VAI and the TyG index both had statistically significant cut-off values in both sexes and a larger ROC area than the HOMA-IR index in predicting MetS.

CONCLUSIONS

The VAI and TyG index are effective indicators in assessing the MetS risk in children with obesity. Both indexes can be considered useful tools in pediatric research and the evaluation of interventions. However, the HOMA-IR index formula needs to be developed taking into account age, gender, and ethnicity.

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.

Derivation and Validation of a New Visceral Adiposity Index for Predicting Short-Term Mortality of Patients with Acute Ischemic Stroke in a Chinese Population

The visceral adiposity index (VAI) is related to the occurrence of various cardiometabolic diseases, atherosclerosis, and stroke. However, few studies have analyzed the impact on the short-term prognosis of stroke. We assessed the effect of VAI on short-term prognoses in patients with acute ischemic stroke through a retrospective cohort study of 225 patients with acute stroke who were admitted to the neurological intensive care unit of our hospital. We collected metabolic indicators (blood pressure, fasting glucose, lipids), National Institutes of Health Stroke Scale (NIHSS) scores, symptomatic intracranial hemorrhage, and other disease evaluation indicators on 197 patients who were screened for inclusion. VAI was calculated by using baseline data (sex, height, weight, waist circumference (WC)). We assessed functional recovery according to modified Rankin scale scores after 90 days. The receiver operating characteristic (ROC) curve was used to calculate the VAI cutoff value that affects short-term outcomes. A nomogram that can predict the risk of short-term mortality in patients with acute ischemic stroke was drawn. In total, 28 patients died within 90 days. Those patients had higher VAI (p = 0.000), higher triglyceride (TG) (p = 0.020) and NIHSS scores (p = 0.000), and lower high-density lipoprotein cholesterol (HDL-C) (p = 0.000) than patients who survived. VAI had higher predictive value of short-term mortality than did body mass index (BMI), body fat mass index (BFMI), and WC. VAI and NIHSS scores were independent risk factors for the short-term mortality of patients with stroke. Patients with a VAI > 2.355 had a higher risk of short-term mortality. VAI has a predictive value higher than that of traditional metabolic indicators such as BMI, BFMI, and WC. The nomogram, composed of NIHSS, VAI, HDL-C, and TG, may predict the short-term mortality of cerebral infarction patients.

Visceral adiposity index is a better predictor to discriminate metabolic syndrome than other classical adiposity indices among young adults

BACKGROUND

Visceral adiposity index (VAI) has been identified as a cardiometabolic risk marker in children and adolescents which reflects abdominal fat distribution. The aim of the present study was to evaluated the predictive capacity of VAI, a body shape index (ABSI), atherogenic index of plasma (AIP), and triglycerides and glucose index (TyG index) compared with classical anthropometric measurements to discriminate metabolic syndrome (MetS).

METHODS

This retrospective study included 1372 individuals. Anthropometric, clinical, and biochemical measurements were used to screen the prevalence of MetS components and to calculate VAI, ABSI, TyG index, and AIP.

RESULTS

The discriminatory capacity among the variables was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). VAI was the variable with the highest AUC with 0.932 CI 95% (0.917-0.948), followed by AIP with 0.914 CI 95% (0.897-0.931), and TyG index with 0.889 CI 95% (0.871-0.908).

CONCLUSION

VAI is a promising tool to identify MetS in the late adolescence setting. Among the novel adiposity indexes VAI, AIP, TyG index are able to determine MetS presence, while ABSI is not capable.

Assessment of a consensus definition of obesity and metabolic health phenotypes in children at different pubertal stages

Not all individuals with obesity develop metabolic complications, which has brought about the concepts of metabolically healthy and unhealthy obesity (MHO/MUO). However, inconsistent definitions of these conditions have limited their understanding. We assessed whether a recently-proposed consensus definition for MHO/MUO correlates with adiposity and reflects metabolic risk parameters during puberty. Low-middle income children from the Growth and Obesity Cohort Study (Santiago, Chile) were included (n = 949; 1692 visits at Tanner (T)2, T4 and/or one-year post menarche (1YPM)). Anthropometry, body composition and metabolic parameters were compared between MUO and MHO, and also in children without obesity. The risk for presenting MUO phenotype was significantly elevated with higher waist-height ratio (T2), zBMI (T2, T4), trunk fat, and C-reactive protein (T4). Elevated cardiometabolic indices were important predictors of the "unhealthy" phenotype allocation in children with or without obesity. Our observations suggest that the consensus definition in children at T2, T4 and 1YPM reflects metabolic risk and central obesity. Metabolic health phenotype allocation by this equation enables easy detection of risk factors that call for action to prevent long-term metabolic derangements in children with obesity and, importantly, also those without obesity.

The accuracy of triglyceride-glucose (TyG) index for the screening of metabolic syndrome in adults: A systematic review and meta-analysis

AIMS

To investigate the relationship between the triglyceride-glucose (TyG) index, a novel surrogate index of insulin resistance (IR), and metabolic syndrome (MetS) in a systematic review and meta-analysis.

DATA SYNTHESIS

Studies that report the TyG index in adult subjects with and without MetS were included. Thirteen observational articles were included in this study, with a total of 49,325 participants. Two different categories of meta-analyses were performed. First, the means of the TyG index were compared in participants with and without MetS. The pooled mean difference (MD) of the TyG index between groups was 0.83 units (CI 95: 0.74-0.92, I2 = 98, P-value < 0.001), and the subgroup analyses showed MD significantly differed based on the MetS diagnostic criteria. The pooled MD were 0.80 units (CI 95: 0.70-0.91, I2 = %88, P-value < 0.001) and 0.82 units (CI 95: 0.79-0.86, I2 = %0, P-value > 0.767) for studies reported data for males and females individual, respectively. Second bivariate diagnostic test accuracy (DTA) meta-analysis was performed and determined that the TyG index's pooled sensitivity and specificity for screening of MetS were 80% (CI95: 75%-84%, I2 = 87%, P-value < 0.001) and 81% (CI95: 77%-84%, I2 = 90.45%, P-value < 0.001), respectively. Summary receiver-operating characteristics (sROC) curves were also plotted with the area under the sROC curve of 0.87 (CI 95: 0.84-0.90).

CONCLUSIONS

The TyG index is a sensitive and specific index for MetS and may be valuable for MetS screening.

PROSPERO

CRD42022316209.

Association between visceral adiposity index and kidney stones in American adults: A cross-sectional analysis of NHANES 2007–2018

Objective

To explore the association between Visceral Adiposity Index (VAI) and kidney stones in an American adult population.

Materials and methods

National Health and Nutrition Examination Survey (NHANES) datasets from 2007 to 2018 were used. Participants aged ≥20 years who reported kidney stone history and VAI were included. Weighted proportions, multivariable analysis, generalized additive model (GAM), and spline smoothing were used to evaluate the associations between VAI and kidney stones by adjusting gender, age, race, education, marital status, poverty income ratio, smoking, alcohol, high blood pressure, diabetes, congestive heart failure, cancer, vigorous activity, moderate activity, HEI2015 total score, and energy.

Results

Totally 13,871 American adults were included. All the participants were divided by the VAI into four groups according to the quartile: Q1 (11.96–42.89), Q2 (42.90–74.45), Q3 (74.45–131.43), and Q4 (131.45–611.34). The mean ± standard deviation of the VAI in the four groups were Q1 (29.07 ± 8.22), Q2 (57.53 ± 8.81), Q3 (99.52 ± 16.25), and Q4 (225.92 ± 95.83). In the fully adjusted multivariable model, VAI was positively correlated with urolithiasis [odds ratio (OR) = 1.001; 95% confidence interval (CI) 1.000–1.001]. Compared with the first quartile of VAI, the population in the fourth quartile of VAI had a higher prevalence of kidney stones (OR = 1.329; 95% CI 1.104–1.600). Subgroup analysis detected no significant interaction effect after adjusting for covariates.

Conclusion

The value of VAI is positively correlated with the prevalence of kidney stones, which suggest VAI can be used to assess the potential risk of the prevalence of kidney stones.

Changes in Novel Anthropometric Indices of Abdominal Obesity during Weight Loss with Selected Obesity-Associated Single-Nucleotide Polymorphisms: A Small One-Year Pilot Study

Whether BMI and the competing waist circumference (WC)-based anthropometric indices are associated with obesity-related single-nucleotide polymorphisms (SNPs) is as yet unknown. The current study aimed to evaluate the anthropometric indices (fat mass index, body shape index, visceral adiposity index, relative fat mass, body roundness index, and conicity index) during a weight loss intervention in 36 obese individuals. Blood biochemical parameters (total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides) and three SNPs (FTO rs9939609, TFAP2B rs987237, and PLIN1 rs894160) were assessed in 22 women and 14 men (35.58 ± 9.85 years, BMI 35.04 ± 3.80 kg/m2) who completed a 12-month balanced energy-restricted diet weight loss program. Body composition was assessed via bioelectrical impedance (SECA mBCA515). At the end of the weight loss intervention, all anthropometric indices were significantly reduced (p < 0.05). For the SNP FTO rs9939609, the higher risk allele (A) was characteristic of 88.9% of the study group, in which 10 participants (27.8%) were homozygous. We found a similar distribution of alleles in TFAP2B and PLIN1. Heterozygous genotypes in FTO rs9939609 and TFAP2B rs987237 were predisposed to significant reductions in WC-based novel anthropometric indices during weight loss. The influence of PLIN1 rs894160 polymorphisms on the changes in the analyzed indices during weight loss has not been documented in the present study.

High Tg/HDL-Cholesterol Ratio Highlights a Higher Risk of Metabolic Syndrome in Children and Adolescents with Severe Obesity

Few data are currently available on the reliability of the different anthropometric, instrumental and biochemical indexes in recognizing the presence of metabolic syndrome (MetS) in children and adolescents with severe obesity. Therefore, the objective of our study was to find out the simplest and most accurate predictive index of MetS in this population at-risk. In 1065 children and adolescents (563 f, 502 m), aged 14.6 ± 2.1 years (range 10–17), with severe obesity [BMI-SDS 3.50 ± 0.36 (range 3.00–5.17)], the following indexes were evaluated: BMI, BMI-SDS, Tri-Ponderal Mass Index, Waist-to-Height ratio, TG/HDL-Cholesterol ratio, Cardiometabolic Index (CMI), and Visceral Adiposity Index (VAI). For each subject, all the components of MetS, defined according to the IDF criteria, were determined. Overall, the presence of MetS was found in 324 patients (30.4%), 167 males (33.3%) and 157 females (27.9%). According to the ROC analysis, three indexes (VAI, CMI and TG/HDL-Cholesterol ratio), performed significantly better than the other ones in identifying MetS, with no difference among them. In conclusion, the TG/HDL ratio, which just needs the evaluation of two simple biochemical parameters, offers the same accuracy as other more sophisticated indexes in recognizing MetS in children and adolescents with severe obesity, thus making it the best predictor to be easily used.

Visceral adiposity index performed better than traditional adiposity indicators in predicting unhealthy metabolic phenotype among Chinese children and adolescents

The relationship between visceral adiposity index (VAI) and unhealthy metabolic phenotype remained unclear in children and adolescents. This study aimed to investigate their association and compared the ability of VAI and traditional adiposity indicators (body mass index, waist circumference and waist-to-height ratio) to predict metabolically unhealthy phenotype among normal-weight, overweight and obese children and adolescents. In this cross-sectional study, 1722 children and adolescents aged 12-18 years were selected by cluster random sampling, underwent a questionnaire survey, physical examination and biochemical tests. Participants were divided into four phenotypes according to the combination of the weight status determined by body mass index (BMI) and metabolic syndrome components. Receiver operating characteristic (ROC) analysis and multivariate logistic regression were used to compare the predictive capacity between VAI and traditional adiposity indicators and their relationship with metabolically unhealthy phenotype. We found that VAI had better performance in predicting metabolically unhealthy phenotype than traditional adiposity indicators, the area under the receiver-operating characteristic curve (AUC) were 0.808 and 0.763 for boys and girls with normal-weight, 0.829 and 0.816 for boys and girls with overweight and obese (all P < 0.001). VAI was most strongly related to metabolically unhealthy phenotype whether or not to adjust the age, the adjusted OR and 95%CI was 6.15 (4.13-9.14) in boys with normal weight, and 5.90 (3.06-11.36), 4.95 (2.35-10.41) in boys and girls with overweight and obese, respectively (all P < 0.001). Our findings suggested VAI could be used as a comprehensive predictor to identify unhealthy metabolic phenotype in children and adolescents.

Visceral Adiposity Index Plays an Important Role in Prognostic Prediction in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome and Type 2 Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

Background: Visceral adiposity index (VAI), a surrogate marker of adiposity and insulin resistance, has been demonstrated to be significantly related to cardiovascular disease. It remains indistinct whether VAI predicts adverse prognosis after percutaneous coronary intervention (PCI) for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and type 2 diabetes mellitus (T2DM). Methods: A total of 798 participants who met the enrollment criteria were finally brought into this study. VAI was determined by waist circumference, body mass index, fasting triglyceride, and high-density lipoprotein cholesterol as previously reported. Adverse prognosis included all-cause death, non-fatal myocardial infarction, non-fatal ischemic stroke, and ischemia-driven revascularization, the composite of which was defined as the primary endpoint. Results: Higher VAI maintained as a significant and independent risk predictor for the primary endpoint, regardless of the adjustment for the various multivariate models [hazard ratio (95% CI) for fully adjusted model: 2.72 (2.02-3.68), p < 0.001]. The predictive value of VAI was further confirmed in sensitivity analysis where VAI was taken as a continuous variate. There was a dose-response relationship of VAI with the risk of the primary endpoint (p for overall association < 0.001). Moreover, the ability of VAI on the prediction of the primary endpoint was consistent between subgroups stratified by potential confounding factors (all p for interaction > 0.05). VAI exhibited a significant incremental effect on risk stratification for the primary endpoint beyond existing risk scores, expressed as increased Harrell's C-index, significant continuous net reclassification improvement, and significant integrated discrimination improvement. Conclusion: VAI is a significant indicator for predicting worse prognosis and plays an important role in risk stratification among patients with NSTE-ACS and T2DM undergoing elective PCI. The present findings require further large-scale, prospective studies to confirm.

Interaction between Autonomic Regulation, Adiposity Indexes and Metabolic Profile in Children and Adolescents with Overweight and Obesity

Early obesity predicts initial modifications in cardiac and vascular autonomic regulation. The aim of this study was to assess the possible interaction between non-invasive measures of autonomic cardiovascular control and peripheral endothelium regulation in children with overweight and obesity. We involved 114 young subjects (77M/37F, 12.7 ± 2.2 years) with normal weight (NW, n = 46) to overweight or obesity (OB, n = 68). Multivariate statistical techniques utilizing a collection of modern indices of autonomic regulation, adiposity indexes and metabolic profile were employed. Resting values show substantial equivalence of data. Conversely, blood pressure variance is greater in NW/OB groups. The correlation matrix between major autonomic and metabolic/hemodynamic variables shows a clustered significant correlation between homogeneous indices. A significant correlation between metabolic indices and endothelial and autonomic control, mostly in its vascular end, was recorded. Particularly, the alpha index is significantly correlated with triglycerides (r = −0.261) and endothelial indices (RHI, r = 0.276). Children with obesity show a link between indices of autonomic and endothelial function, fat distribution and metabolic profile. The optimization of autonomic control, for instance by exercise/nutrition interventions, could potentially prevent/delay the occurrence of structural vascular damage leading to reduced cardiovascular health.

Predictive factors of polycystic ovary syndrome in girls with precocious pubarche

OBJECTIVE

The aim of this study is to clarify, in girls with premature pubarche (PP), the influence of premature androgenization on the prevalence of polycystic ovary syndrome (PCOS).

DESIGN AND PATIENTS

Ninety-nine PP girls, 63 who developed PCOS and 36 who did not develop PCOS, were retrospectively included. Clinical, anthropometric, and metabolic parameters were evaluated at the time of diagnosis of PP and after 10 years from menarche to find predictive factors of PCOS.

RESULTS

Young females with PP showed a PCOS prevalence of 64% and showed a higher prevalence of familial history of diabetes (P = 0.004) and a lower prevalence of underweight (P = 0.025) than PP-NO-PCOS. In addition, girls with PP-PCOS showed higher BMI (P < 0.001), waist circumference (P < 0.001), total testosterone (P = 0.026), visceral adiposity index (VAI) (P = 0.013), total cholesterol (P < 0.001), LDL-cholesterol (P < 0.001), non-HDL cholesterol (P < 0.001) and lower age of menarche (P = 0.015), ISI-Matsuda (P < 0.001), DIo (P = 0.002), HDL cholesterol (P = 0.026) than PP-NO-PCOS. Multivariate analysis showed that WC (P = 0.049), ISI-Matsuda (P < 0.001), oral disposition index (DIo) (P < 0.001), VAI (P < 0.001), total testosterone (P < 0.001) and LDL-cholesterol (P < 0.001) are independent predictive factors for PCOS in girls with PP.

CONCLUSIONS

Our study established a strong association between multiple risk factors and development of PCOS in PP girls. These risk factors are predominantly related to the regulation of glucose, lipid, and androgen metabolism. Among these factors, WC, ISI-Matsuda, DIo, VAI, total testosterone, and LDL-cholesterol predict PCOS.