March 04, 2020
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Inclusion of visceral abdominal fat area fails to improve diabetes risk assessment

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Determining diabetes risk among Chinese adults is not improved by assessing visceral fat area instead of waist-to-hip ratio or waist circumference, according to findings published in the Journal of Diabetes Investigation.

“The present study showed that visceral abdominal fat area performs no better than waist circumference and waist-to-hip ratio as an indicator of a high risk factor for hyperglycemia among a healthy Chinese population,” Linong Ji, MD, a professor in the department of endocrinology at Peking University People’s Hospital in Beijing, and colleagues wrote. “Additional research is required to study other central obesity-related anthropometrics measures and their association with diabetes.”

Ji and colleagues used CT to assess baseline visceral fat area in 3,572 adults from the Pinggu Metabolic Disease Study (51.5% women; mean age, 53.9 years in men, 54.1 years in women). The researchers also assessed fasting plasma glucose, 2-hour post prandial glucose, HbA1c, disposition index, waist circumference, waist-to-hip ratio, waist-to-height ratio, subcutaneous abdominal fat area, ratio of visceral to subcutaneous fat, and total body weight at baseline.

Prediabetes was defined as an FPG level of at least 5.6 mmol/L, 2-hour postprandial glucose level of at least 7.8 mmol/L, HbA1c of at least 5.7% and/or a sub-25th percentile disposition index reading.

Doctor and tape measure 2019 
Determining diabetes risk among Chinese adults is not improved by assessing visceral fat area instead of waist-to-hip ratio or waist circumference.
Source: Adobe Stock

Influencing glucose measurements

The researchers found the three adiposity measurements related to the highest odds of meeting the FPG threshold were high waist circumference, waist-to-height ratio and waist-to-hip ratio. The odds of reaching the threshold rose by 70% when waist circumference rose by 1 standard deviation (OR = 1.7; 955 CI, 1.57-1.84), by 68% when waist-to-height ratio rose by 1 standard deviation (OR = 1.68; 95% CI, 1.55-1.82) and by 64% when waist-to-hip ratio rose by 1 standard deviation (OR = 1.64; 95% CI, 1.51-1.78). As for visceral fat area, the odds of meeting the FPG threshold rose by 61% when visceral fat area rose by 1 standard deviation (OR = 1.61; 95% CI, 1.48-1.74).

The three adiposity measurements related to the highest odds of meeting the 2-hour postprandial glucose threshold were high waist-to-hip ratio, waist-to-height ratio and visceral fat area. The odds of reaching the threshold rose by 83% when waist-to-hip ratio rose by 1 standard deviation (OR = 1.83; 95% CI, 1.68-2) and by 80% when waist-to-height ratio (OR = 1.8; 95% CI, 1.66-1.96) or visceral fat area (OR = 1.8; 95% CI, 1.65-1.94) rose by 1 standard deviation.

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Effects on HbA1c, disposition index

The three adiposity measurements related to the highest odds of meeting the HbA1c threshold were high body weight, waist circumference and waist-to-height ratio. The odds of reaching the threshold rose by 87% when body weight (OR = 1.87; 95% CI, 17-2.5) or waist circumference (OR = 1.87; 95% CI, 1.71-2.04) rose by 1 standard deviation and by 83% when waist-to-height ratio rose by 1 standard deviation (OR = 1.83; 95% CI, 1.68-1.99). Meanwhile, the odds of meeting the HbA1c threshold rose by 79% when visceral fat area rose by 1 standard deviation (OR = 1.79; 95% CI, 1.64-1.94).

Lastly, when they rose by 1 standard deviation, the adiposity measurements that were related to the highest odds of meeting the disposition index included waist-to-hip ratio (OR = 1.67; 95% CI, 1.53-1.83), waist circumference (OR = 1.65; 95% CI, 1.51-1.8), body weight (OR = 1.56; 95% CI, 1.43-1.71) and visceral fat area (OR = 1.56; 95% CI, 1.44-1.7).

The researchers noted that “visceral fat area performs better as an anthropometrics indicator in predicting hyperglycemic risk in women than men.”

“The present study has strong public health implications,” the researchers wrote. “Among a healthy population, the need for measuring abdominal fat through CT scan or other diagnostics to predict diabetes is not urgent, where the more convenient measures, including waist circumference and waist-to-hip ratio, could show hyperglycemic risk well.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.