A study of visceral adiposity index as a diagnostic index in gestational diabetes mellitus in a tertiary care centre

Abstract

INTRODUCTIONGestational Diabetes Mellitus (GDM) affects up to 15% of pregnant women worldwide and an estimated 4 million women in India.1 Early detection and initiation of treatment reduces adverse maternal and foetal outcomes. Most of the pregnancies that develop GDM is associated with dyslipidemia, the assessment of which in the 2nd trimester could serve as a potential diagnostic tool. Pregnant women destined to develop GDM had higher total cholesterol, LDL, triglycerides, CRP, and t-PA but ABSTRACTBackground: Gestational Diabetes Mellitus is an emerging problem which affects pregnant women all over the world particularly in India. Early detection reduces adverse maternal and foetal outcome. Elevated central adiposity is a modifiable risk factor for abnormal glucose homeostasis in pregnancy and GDM. The Visceral Adiposity Index (VAI) is a gender-specific index of fat distribution and assessment. Methods: It is a hospital based, case control study among the subjects who attended a tertiary care centre. cases were 30 pregnant women newly diagnosed with GDM in their 2nd trimester, and Controls were 30 apparently healthy pregnant women in their 2nd trimester without risk factors for GDM such as obesity and family history for diabetes. Visceral Adiposity Index (VAI) was calculated using the formula (Waist circumference (WC)/ {36.58 +(1.89xBMI)}) x(TGL/0.81) x (1.52/HDL) where WC is expressed in cm, BMI in Kg/m2, TG in mmol/L, HDL in mmol/L. Results: The mean age of patients with GDM was higher when compared to controls (28.17 ± 3.34vs 24.40±3.07) and this difference was statistically significant (p value < 0.0001). The average weights were significantly different. The mean Body Mass Index (BMI) and waist circumference (WC) was 23.59 ± 4.19 and 88.46 ± 7.10 respectively among controls and 29.85 ±4.52 and 102.12 ± 6.96 respectively among GDM patients and these differences were highly significant (p value<0.0001). The lipid profile of these patients showed a significantly higher value of Triglycerides among patients. Conclusions:This study correlates GDM with Visceral adiposity index and found that the index to be elevated in the GDM group. The increased VAI in GDM patients shows their elevated adipose tissue distribution. VAI is less invasive and cost effective, can be used as a diagnostic index in GDM.

Association between maternal adiposity measures and adverse maternal outcomes of pregnancy: Systematic review and meta‐analysis

“…Searches identified 24,027 studies following removal of duplicates; 945 full texts were screened for eligibility, of which 70 20,21,37–104 met the inclusion criteria (Figure S1). Of these studies, 59 were cohort and 11 were case control studies.…”

“…Study settings were Asia ( n = 25; China n = 9, India n = 5, Iran n = 4, Turkey n = 3, Pakistan n = 2, Japan n = 1, South Korea n = 1), North America ( n = 17; Canada n = 9, the United States n = 8), Europe ( n = 14; the United Kingdom n = 6, Italy n = 3, multi‐country n = 2, Finland n = 1, Poland n = 1, Russia n = 1, Spain n = 1), Australia ( n = 6), Africa ( n = 3; Ethiopia, Ghana, Nigeria), South America ( n = 3; Brazil), and one multi‐continent (including data from Australia, New Zealand, the United Kingdom, and Ireland) (Table S3). Ten of the included studies only included women within certain BMI categories; five included only women with obesity (BMI ≥ 30.0 kg/m 2 ), 41,52,73,76,97 two included women with an overweight or obese BMI (≥25.0 kg/m 2 ), 61,67 and three included women with BMI < 30.0 kg/m 2 40,48,54 . Early pregnancy WC was the most frequently reported adiposity measure ( n = 35 studies), followed by waist to hip ratio (WHR) ( n = 19), measures of fat mass (FM) and fat‐free mass (FFM) ( n = 15), visceral fat ( n = 13), subcutaneous fat ( n = 11), hip circumference ( n = 7), neck circumference ( n = 7), arm circumference and skinfold thickness (SFT) ( n = 5 each), waist to height ratio ( n = 4), total adipose fat ( n = 3), leg/thigh circumference and visceral to subcutaneous fat ratio ( n = 2), and n = 1 each for visceral adiposity index, FM index, FFM index, wrist circumference, neck to thigh ratio, waist to thigh ratio, ratio of visceral fat thickness to subcutaneous fat thickness, FM to FFM ratio, combined WC and BMI, combined WHR and BMI, the presence of maternal hepatic fat, and/or the upper quartile of either visceral adipose tissue or total adipose tissue (Table S4).…”

“…Fourteen studies reported associations between measures of WC and a diagnosis of GDM 46,51,55,57–60,72,77,83,86,88,97,103 and 16 reported case control data for early pregnancy WC between women diagnosed with GDM during pregnancy (cases) and women not diagnosed with GDM (controls) 37,46–48,52,57–60,67,73,78,80,83,88,103 . Nine studies reported categorical measures of WC 37,46,51,55,57,58,60,83,86,103 and eight could be pooled in the meta‐analysis (Figure 1).…”

“…Sixteen studies reported case control data and all could be included in a meta‐analysis 37,46–48,52,57–60,67,73,78,80,83,88,103 . The pooled data showed a significantly increased early pregnancy WC among women diagnosed with GDM compared with those not diagnosed with GDM (mean difference 6.18 cm, 95% CI 3.92, 8.44) (Figure 3).…”

“…Ten of the included studies only included women within certain BMI categories; five included only women with obesity (BMI ≥ 30.0 kg/m 2 ), 41,52,73,76,97 two included women with an overweight or obese BMI (≥25.0 kg/m 2 ), 61,67 and three included women with BMI < 30.0 kg/m 2 . 40,48,54 Early pregnancy WC was the most frequently reported adiposity measure (n = 35 studies), followed by waist to hip ratio (WHR) (n = 19), measures of fat mass (FM) and fat-free mass (FFM) (n = 15), visceral fat (n = 13), subcutaneous fat (n = 11), hip circumference (n = 7), neck circumference (n = 7), arm circumference and skinfold thickness (SFT) (n = 5 each), waist to height ratio (n = 4), total adipose fat (n = 3), leg/thigh circumference and visceral to subcutaneous fat ratio (n = 2), and n = 1 each for visceral adiposity index, FM index, FFM index, wrist circumference, neck to thigh ratio, waist to thigh ratio, ratio of visceral fat thickness to subcutaneous fat thickness, FM to FFM ratio, combined WC and BMI, combined WHR and BMI, the presence of maternal hepatic fat, and/or the upper quartile of either visceral adipose tissue or total adipose tissue (Table S4). The majority of outcome data related to GDM (n = 45 studies), followed by hypertensive disorders (n = 20; including preeclampsia and pregnancy-induced hypertension), measures of insulin and glucose (in the absence of reporting GDM diagnosis, n = 7), maternal lipids (n = 6), caesarean delivery (n = 5), composite outcomes (n = 4), induction or assisted deliveries (n = 3), metabolic syndrome (n = 2), non-spontaneous labor (n = 1), and gestational weight gain (n = 1) (Table S4).…”