Ratio of visceral‐to‐subcutaneous fat area predicts cardiovascular events in patients with type 2 diabetes

Abstract

Aims/IntroductionTo investigate whether the ratio of visceral fat area (VFA) to subcutaneous fat area (SFA; V/S ratio) could be predictive of cardiovascular disease (CVD) as compared with VFA or SFA in patients with diabetes.Materials and MethodsA total of 682 patients with type 2 diabetes (mean age 64 ± 13 years; 41% women) were enrolled. VFA (cm2) and SFA (cm2) were assessed by a dual bioelectrical impedance analyzer. The patients were divided into four groups according to the quartiles of the V/S ratio. The study end‐point was the first occurrence or recurrence of CVD.ResultsOver a median follow up of 2.5 years, 21 patients reached the end‐point. The number of patients who reached the end‐point was increased along with the increasing of the V/S ratio quartiles. The V/S ratio was significantly associated with incident or recurrent CVD (hazard ratio [HR] 1.82, 95% CI: 1.09–3.04, P = 0.021) after adjusting for estimated glomerular filtration rate (HR 0.98, 95% CI: 0.96–1.00), brain‐type natriuretic peptide (HR 1.00, 95% CI: 1.00–1.01), use of antiplatelet agents (HR 4.26, 95% CI: 1.63–11.13), coefficient of variation of R‐R intervals (HR 0.85, 95% CI: 0.69–1.10) and glycated hemoglobin (HR 1.37, 95% CI: 1.05–1.79). The addition of the V/S ratio to age, estimated glomerular filtration rate, brain‐type natriuretic peptide, antiplatelet agents and glycated hemoglobin significantly improved classification performance for CVD using net reclassification improvement (0.60, 95% CI: 0.21–1.00) and the integrated discrimination improvement (0.02, 95% CI: 0.00–0.05).ConclusionsThe V/S ratio measured by dual bioelectrical impedance analyzer is an independent predictor of CVD in patients with type 2 diabetes.

Comparison of Computed Tomography-based Abdominal Adiposity Indexes as Predictors of Non-alcoholic Fatty Liver Disease Among Middle-aged Korean Men and Women

“…In another cross-sectional study of 408 adults, a larger amount of femoral subcutaneous fat was negatively associated with NAFLD in women, but not in men [25]. VSR can be a useful index to identify individuals at risk of cardiovascular disease [7,8] and metabolic syndrome [15]. Higher VSR, as assessed by a dual bioelectrical impedance analyzer, has been found to be associated with cardiovascular events in patients with type 2 diabetes who regularly visited the university hospital in Tokyo, Japan [7].…”

“…Although WC is a good general indicator of the total amount of abdominal fat, it does not distinguish between visceral fat and subcutaneous fat, which may have different relationships with metabolic diseases. NAFLD is associated with an increase in visceral fat and a decrease in subcutaneous fat even at identical WC measurements [4][5][6][7][8][9]. Since many studies have reported that visceral fat is a greater contributor to NAFLD development than subcutaneous fat, measurements of the amount of visceral fat in absolute terms or relative to subcutaneous fat have been suggested as indicators of abnormal abdominal fat presence [10][11][12][13][14].…”

Sarcopenic obesity assessed using dual energy X-ray absorptiometry (DXA) can predict cardiovascular disease in patients with type 2 diabetes: a retrospective observational study

“…Actually, Mahabadi et al reported that visceral fat tissue measured by CT is significantly associated with CVD even after adjusted for the covariates including BMI and WC, indicating the inaccuracy of WC for the measurement of visceral adiposity to estimate future CVD events [ 40 ]. In addition, we previously demonstrated that the ratio of abdominal visceral-to-subcutaneous fat area measured by a dual bioelectrical impedance analyzer independently of cardiovascular risk factors can predict CVD events in patients with type 2 diabetes [ 6 ]. To overcome the defect of WC, a body shape index (ABSI) has been recently developed as a new anthropometric parameter based on WC, BMI and height for the assessment of visceral adiposity [ 41 ].…”

“…In particular, visceral adiposity is reported to have greater impact on metabolic abnormalities [ 2 ], CVD [ 3 ], and mortality [ 4 ], compared with total adiposity as usually represented by body mass index (BMI). A recent large-scale prospective study revealed that visceral adiposity has been more useful to predict the risk of CVD than BMI in mostly non-diabetic subjects [ 5 ], and we showed that not BMI but visceral fat accumulation measured by dual bioelectrical impedance analyzer could predict incident CVD in patients with type 2 diabetes [ 6 ]. CVD is the leading cause of death in diabetic patients [ 7 ], therefore, accurate assessment of visceral fat accumulation is critical for assessing the risk of CVD, especially in patients with diabetes.…”

O-GlcNAc transferase inhibits visceral fat lipolysis and promotes diet-induced obesity

“…Besides the overall obesity, the anatomical location of fat also matters in disease development. Studies have shown that intra-abdominal visceral fat is strongly positively correlated with obesity-related diseases, while peripheral subcutaneous fat seems to have no effect or even a protective effect against developing metabolic syndrome [6][7][8][9][10] . However, the biological and genetic differences between visceral and subcutaneous fat are poorly understood.…”