Visceral adiposity index, hypertriglyceridemic waist and risk of diabetes: the China Health and Nutrition Survey 2009

Background:The visceral adiposity index (VAI) and hypertriglyceridemic waist phenotype (the simultaneous presence of waist circumference (WC)⩾90/80 cm for men/women and plasma triglyceride (TG) concentration⩾1.7 mmol l−1 for both genders) have been identified as good indicators of visceral adiposity, which is an independent risk factor for diabetes. The Chinese population is characterized by a predominance of visceral fat accumulation despite having comparatively low weight. These two surrogate markers of visceral adiposity might effectively identify Chinese adults who are at risk of getting diabetes. We aimed to examine the association between VAI and risk of diabetes or between the hypertriglyceridemic waist phenotype and diabetes risk.Methods:We conducted a cross-sectional analysis of 7639 Chinese men and women aged ⩾18 years using data from the China Health and Nutrition Survey 2009. Logistic regression was used to evaluate the associations.Results:For men, compared with participants in the lowest quartile of VAI scores, the multivariable-adjusted odds ratios (ORs) (with 95% confidence intervals) for diagnosed diabetes were 1.1 (0.7–1.7), 1.9 (1.3–2.8) and 3.6 (2.5–5.3) for those in the second, third, and top quartile of VAI scores, respectively. For women, the corresponding figures were 0.9 (0.5–1.4), 1.7 (1.1–2.6) and 2.8 (1.9–4.2), respectively. The multivariate-adjusted ORs (with 95% confidence intervals) for diabetes in men with the hypertriglyceridemic waist phenotype compared with men with both WC and TG measurements below the defined cut points were 3.7 (2.6–5.4). For women, the corresponding figure was 3.7 (2.4–5.5). For both men and women, the associations between the 4th quartile of VAI scores and risk of diabetes or between the hypertriglyceridemic waist phenotype and risk of diabetes were consistently seen in various subgroups.Conclusion:Among Chinese adults, high VAI scores and the hypertriglyceridemic waist phenotype are strongly associated with diabetes risk.

[1]  A. Thanopoulou,et al.  Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. , 2010, The New England journal of medicine.

[2]  X. Shu,et al.  Visceral adiposity and risk of coronary heart disease in relatively lean Chinese adults. , 2013, International Journal of Cardiology.

[3]  Claus Christiansen,et al.  Enlarged Waist Combined With Elevated Triglycerides Is a Strong Predictor of Accelerated Atherogenesis and Related Cardiovascular Mortality in Postmenopausal Women , 2005, Circulation.

[4]  D. Gaudet,et al.  Hypertriglyceridemic waist: A marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men? , 2000, Circulation.

[5]  E. Boyko,et al.  Visceral adiposity and risk of type 2 diabetes: a prospective study among Japanese Americans. , 2000, Diabetes care.

[6]  G. Rossi,et al.  Diagnosis and Classification of Diabetes Mellitus The information that follows is based largely on the reports of the Expert Committee on the Diagnosis and Classification of Diabetes (Diabetes Care 20:1183–1197, 1997, and Diabetes Care 26:3160–3167, 2003). , 2008, Diabetes Care.

[7]  Masafumi Matsuda,et al.  Metabolic effects of visceral fat accumulation in type 2 diabetes. , 2002, The Journal of clinical endocrinology and metabolism.

[8]  N. J. Wareham,et al.  The hypertriglyceridemic-waist phenotype and the risk of coronary artery disease: results from the EPIC-Norfolk Prospective Population Study , 2010, Canadian Medical Association Journal.

[9]  R. Sladek,et al.  Characterizing the profile of obese patients who are metabolically healthy , 2011, International Journal of Obesity.

[10]  E. Ferrannini,et al.  Insulin resistance and hypersecretion in obesity. European Group for the Study of Insulin Resistance (EGIR). , 1997, The Journal of clinical investigation.

[11]  A. Mokdad,et al.  Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. , 2003, JAMA.

[12]  Bei-fan Zhou Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults. , 2002, Biomedical and environmental sciences : BES.

[13]  P. Toth Impact of Abdominal Visceral and Subcutaneous Adipose Tissue on Cardiometabolic Risk Factors: The Jackson Heart Study , 2011 .

[14]  Wenying Yang,et al.  Prevalence of diabetes among men and women in China. , 2010, The New England journal of medicine.

[15]  B. Popkin,et al.  Cohort Profile: The China Health and Nutrition Survey--monitoring and understanding socio-economic and health change in China, 1989-2011. , 2010, International journal of epidemiology.

[16]  G. Reaven,et al.  The kidney: an unwilling accomplice in syndrome X. , 1997, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[17]  B. Carlin,et al.  ADIPOSE TISSUE DYSFUNCTION IN OBESITY, DIABETES, AND VASCULAR DISEASES , 2009 .

[18]  Udo Hoffmann,et al.  Abdominal Visceral and Subcutaneous Adipose Tissue Compartments: Association With Metabolic Risk Factors in the Framingham Heart Study , 2007, Circulation.

[19]  Y. Liang,et al.  Secular trends in the prevalence of general and abdominal obesity among Chinese adults, 1993–2009 , 2012, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[20]  Ho-Young Son,et al.  Epidemic obesity and type 2 diabetes in Asia , 2006, The Lancet.

[21]  Ian Janssen,et al.  The importance of waist circumference in the definition of metabolic syndrome: prospective analyses of mortality in men. , 2006, Diabetes care.

[22]  Alfonso T. Perez,et al.  Hypertriglyceridemic Waist Phenotype Predicts Increased Visceral Fat in Subjects With Type 2 Diabetes , 2009, Diabetes Care.

[23]  H. White,et al.  Logistic regression in the medical literature: standards for use and reporting, with particular attention to one medical domain. , 2001, Journal of clinical epidemiology.

[24]  A. Khera,et al.  Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults. , 2012, JAMA.

[25]  H. Kahn,et al.  Longitudinal changes in BMI and in an index estimating excess lipids among white and black adults in the United States , 2008, International Journal of Obesity.

[26]  June Stevens,et al.  Anthropometric Measures, Body Composition, Body Fat Distribution, and Knee Osteoarthritis in Women , 2006, Obesity.

[27]  G. Chrousos,et al.  Visceral adiposity index is highly associated with adiponectin values and glycaemic disturbances , 2013, European journal of clinical investigation.

[28]  Jee-young Oh,et al.  The visceral adiposity index as a predictor of insulin resistance in young women with polycystic ovary syndrome , 2013, Obesity.

[29]  P. Macfarlane,et al.  Metabolic Syndrome With and Without C-Reactive Protein as a Predictor of Coronary Heart Disease and Diabetes in the West of Scotland Coronary Prevention Study , 2003, Circulation.

[30]  Ralph B D'Agostino,et al.  Prediction of incident diabetes mellitus in middle-aged adults: the Framingham Offspring Study. , 2007, Archives of internal medicine.

[31]  R. Ross,et al.  Visceral adipose tissue indicates the severity of cardiometabolic risk in patients with and without type 2 diabetes: results from the INSPIRE ME IAA study. , 2012, The Journal of clinical endocrinology and metabolism.

[32]  R. Ross,et al.  Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity. , 2012, The American journal of clinical nutrition.

[33]  P. Whelton,et al.  Central Rather Than Overall Obesity Is Related to Diabetes in the Chinese Population: The InterASIA Study , 2007, Obesity.

[34]  K. Reynolds,et al.  The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). , 2008, Archives of internal medicine.

[35]  S. Reis,et al.  Clinical Importance of Obesity Versus the Metabolic Syndrome in Cardiovascular Risk in Women: A Report From the Women’s Ischemia Syndrome Evaluation (WISE) Study , 2004, Circulation.

[36]  S. Kahn,et al.  Visceral Adiposity and the Prevalence of Hypertension in Japanese Americans , 2003, Circulation.

[37]  E Bruckert,et al.  Hypertriglyceridemic waist and 7.5-year prospective risk of cardiovascular disease in asymptomatic middle-aged men , 2007, International Journal of Obesity.

[38]  Fritz Schick,et al.  Identification and characterization of metabolically benign obesity in humans. , 2008, Archives of internal medicine.