Visceral Fat Area Is a Better Predictor Than Coronary Artery Calcification Score for Cardiovascular Outcomes and All-Cause Death in Patients on Hemodialysis

Abstract

Objectives: The aim of this study is to compare the prognostic effects of visceral fat area (VFA) with coronary artery calcification score (CACs) in patients on maintenance hemodialysis. Design and Methods: In the prospective study with no intervention, clinical characteristics and serum biochemical indexes at baseline for each patient were collected through the electronic medical records. Body composition assessment using bioelectrical impedance analysis, computed tomography examination with the Agatston scoring method, and echocardiographic measurements were performed at enrollment. Primary endpoints included cardiovascular events (CVEs), cardiovascular death (CVD), and all-cause death. Results: A total of 97 Chinese patients aged 48 (35-62) years were enrolled from our Hemodialysis Center, of which 61.9% were male and 20.6% had diabetes. The median of VFA and CACs at baseline was 64.5 (43.5-88.7) cm 2 and 0.9 (0-467.6), respectively. CVEs occurred in 20 (20.6%) patients during a median follow-up of 26.4 (13-27.7) months. The cardiovascular and all-cause mortality was 8.2% (8 patients) and 11.3% (11 patients), respectively. VFA was associated with CVEs (hazard ratio [HR] 5 9.21 for VFA $71.3 cm 2 vs. VFA ,71.3 cm 2 , P 5 .017), CVD (HR 5 1.11 for 1 cm 2 increase, P 5 .035), and all-cause mortality (HR 5 1.08 for 1 cm 2 increase, P 5 .011). Also, VFA was significantly correlated with cardiac structure parameters and the development of left ventricular hypertrophy (odds ratio 5 1.02 for 1 cm 2 increase, P 5 .03). Yet, CACs were not correlated with CVEs, CVD, or all-cause mortality. Conclusions: Increased VFA can be used as an independent predictor for CVEs, CVD, and all-cause mortality. The effect VFA exerts on cardiac reconstruction might be the underlying mechanism. Further studies are warranted for the management of VFA in the hemodialysis population.

Gut Microbiome Alterations in Patients With Visceral Obesity Based on Quantitative Computed Tomography

“…BMI as the traditional anthropometric parameter can only evaluate the total body fat, but not the fat distribution. In recent years, it has been discovered that central obesity with excessive accumulation of visceral fat significantly increases the risk of atherosclerosis, type 2 diabetes, cancer, and all-cause mortality ( Liu et al., 2019 ; Qiu et al., 2020 ; Xiong et al., 2021 ). This may be because the visceral fat is more active in storing dietary fatty acids, secreting adiponectin and inflammatory factors such as interleukin-6, tumor necrosis factor (TNF)-α, and colony-stimulating factor-1 ( Fontana et al., 2007 ; Harman-Boehm et al., 2007 ; Cartier et al., 2008 ; Kovacova et al., 2012 ; Wang et al., 2012 ; Huang et al., 2015 ; Tsujimoto and Kajio, 2017 ; Barberio et al., 2019 ).…”

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

“…In a study of 97 hemodialysis patients, Xiong et al found that visceral fat determined by BIA was associated with cardiovascular events (HR 9.21; 95% CI 1.49-56.76; visceral fat area ≥71.3 cm 2 vs. <71.3 cm 2 ; p = 0.017), cardiovascular mortality (HR 1.11; 95% CI 1.01-1.22; 1-cm 2 increase in fat mass area; p = 0.035), and all-cause mortality (HR 1.08; 95% CI 1.02-1.14; 1-cm 2 increase in fat mass area; p = 0.011) [110]. Okamoto et al followed 126 patients on maintenance hemodialysis for 60 months and reported multivariate Cox proportional hazards analysis results showing that a visceral fat area of >71.5 cm 2 , determined by CT, was an independent predictor of cardiovascular death (HR 4.46; 95% CI 1.24-16.05; p = 0.022) [111].…”

Nutritional Status of Coronary Artery Disease Patients—Preliminary Results

“…Nutritional status and body composition were not related to the number of significantly lesioned coronary arteries in the presented study, this observation is in line with the fact that the symptoms of CAD do not correlate adequately with the extent of coronary lesions. The observations from other studies suggest the role of visceral fat accumulation as a good predictor for coronary calcification [ 34 ]. These differences might be caused by different methodologies, as in the present study only the number of significantly lesioned arteries was taken into count and total FM was assessed, while in the study by Xiong et al the structural advancement of CAD was assessed with tomography calcium score and segmental BIA was performed [ 34 ].…”

“…The observations from other studies suggest the role of visceral fat accumulation as a good predictor for coronary calcification [ 34 ]. These differences might be caused by different methodologies, as in the present study only the number of significantly lesioned arteries was taken into count and total FM was assessed, while in the study by Xiong et al the structural advancement of CAD was assessed with tomography calcium score and segmental BIA was performed [ 34 ]. However, the mentioned study group was also hemodialysis patients which could interfere BIA results [ 34 ].…”