Association Among Lipid Accumulation Product, Chinese Visceral Obesity Index and Diabetic Retinopathy in Patients with Type 2 Diabetes: A Cross-Sectional Study

Abstract

Background and Aim Obesity often coexists with diabetes, especially abdominal obesity, recognized as a risk factor for diabetic complications. Diabetic retinopathy (DR), as one of the most common microvascular complications of diabetes, may be associated with these indices. Lipid accumulation product (LAP) and Chinese visceral obesity index (CVAI) are novel visceral obesity indicators, which have been proven to be an influential factor predicting type 2 diabetes (T2DM). However, the correlation among LAP, CVAI, and DR still lacks systematic research in T2DM. The study aimed to explore the relationship among LAP, CVAI levels in different DR stages of T2DM patients and the diagnostic efficacy of LAP and CVAI for DR. Methods A total of 263 participants were recruited in this cross-sectional study. We enrolled 169 patients with T2DM, divided into the non-DR group (NDR, n = 61), non-proliferative DR group (NPDR, n = 55), and proliferative DR group (PDR, n = 53). And we also enrolled 94 healthy control participants. We collected demographic, anthropometric, and biochemical data on each subject. LAP and CVAI are calculated according to different formulas for men and women. Results Compared with the control group, LAP and CVAI were significantly higher (P < 0.05). After adjusting for confounding factors, LAP (OR: 1.029, 95CI%: 1.010–1.049, P < 0.05), WC (OR: 1.073, 95CI%: 1.009–1.141, P < 0.05) and CVAI (OR: 1.017, 95CI%: 1.000–1.033, P < 0.05) were all associated with an increased risk of DR. Furthermore, increased LAP (OR: 1.020, 95% CI: 0.100–0.290) is associated with DR severity (P < 0.001). Moreover, the LAP had the most significant area under the receiver operating characteristics (ROC) curve (AUC) (AUC = 0.728, 95% CI: 0.653–0.804). Conclusion A high LAP is associated with an increased risk of DR in T2DM patients, and the LAP index appears to be a good predictor of DR risk and severity in patients with T2DM, compared with BMI, WC, and CVAI.

Association between abdominal obesity and diabetic retinopathy in patients with diabetes mellitus: A systematic review and meta-analysis

“…The Egger regression test results showed no significant publication bias ( p = 0.372). Sensitivity analysis showed that the only study using WHtR as an abdominal obesity indicator by Li et al [ 4 ] had a greater effect on the pooled risk estimates ( S3A Fig ). After this study was removed, sensitivity analysis of the WHR subgroup demonstrated that the observed risk estimate was robust ( S3B Fig ).…”

“…In addition, two studies [ 5 , 9 ] included in this meta-analysis used VAI as the abdominal obesity evaluation parameter, and three studies [ 4 , 9 , 25 ] used LAP. The association between VAI and DR was not statistically significant (SMD -0.13, 95% CI -0.22 to -0.03; p = 0.33, I 2 0.00%) ( Fig 4D ).…”

“…Four of the included studies [ 4 , 18 , 27 , 33 ] separately examined the association between abdominal obesity and diabetic retinopathy of varying severity, including mild or moderate NPDR and VTDR. The results of the meta-regression analysis ( p = 0.558) suggested that DR severity did not lead to high heterogeneity in this meta-analysis ( S5A Fig ).…”

“…Meanwhile, conflicting results have been reported in recent clinical studies on the association between abdominal obesity and DR. Some studies have claimed that abdominal obesity is more associated with DR among people with diabetes mellitus (DM) than general obesity, as measured by body mass index (BMI) [ 4 ]. A study published in 2022 [ 5 ] announced that abdominal obesity was not associated with DR in patients with DM.…”

“…Additionally, their analysis did not explore whether DR of different severities has an equal association with abdominal obesity. In addition, several recent clinical studies have used new measurement parameters to define abdominal obesity, such as lipid accumulation product (LAP) [ 4 ], Visceral fat area (VFA) [ 7 ] and visceral adiposity index (VAI) [ 5 ]. Currently, no meta-analysis have incorporated these parameters to investigate the association between abdominal obesity and DR.…”