Abstract
ObjectivesThe visceral adiposity index (VAI), an indirect marker of visceral adipose tissue, serves as a model associated with cardiometabolic risk, but has limitations regarding the Asian population. We sought to develop a new VAI (NVAI) for the Korean population and compare it to VAI for prediction of atherosclerotic cardiovascular disease (ASCVD) risk and development of major cardiovascular diseases (CVD) and stroke.MethodsPatients (969) who underwent visceral fat area measurement were analyzed. After exclusion, 539 patients (142 men, 397 women) were randomly divided into internal (n = 374) and external validation (n = 165) data set. The NVAI was developed using univariate and multivariate logistic regression with backward selection of predictors. Receiver operating characteristic (ROC) curve analysis and comparison of the area under the curve (AUC) verified the better predictor of ASCVD risk score. Additionally, nationwide population-based cross-sectional survey data (Korean National Health and Nutrition Examination Survey [KNHANES] 2008–2010, n = 29,235) was used to validate the NVAI’s ability to predict ASCVD risk and major CVD and stroke.ResultsThe NVAI better reflected visceral fat area in internal and external data sets, with AUCs of 0.911 (95% confidence interval [CI]: 0.882–0.940) and 0.879 (95% CI: 0.828–0.931), respectively. NVAI better discriminated for ASCVD risk (AUC = 0.892, 95% CI: 0.846–0.938) compared to VAI (0.559, 95% CI: 0.439–0.679). The NVAI also better predicted MI or angina, and stroke with AUCs of 0.771 (95% CI: 0.752–0.789), and 0.812 (95% CI: 0.794–0.830), respectively, compared with waist circumference (WC), body mass index (BMI), TG to HDL ratio, and VAI via KNHANES, in a statistically significant manner.ConclusionsThe NVAI has advantages as a predictor of visceral obesity and is significantly associated with ASCVD risks and development of major CVD and stroke in the Korean population. The NVAI could be a screening tool for improved risk estimation related to visceral obesity.
Highlights
It is well known that abdominal visceral fat is related to insulin resistance regardless of body mass index (BMI)
The new VAI (NVAI) better reflected visceral fat area in internal and external data sets, with area under the curve (AUC) of 0.911 (95% confidence interval [CI]: 0.882–0.940) and 0.879, respectively
NVAI better discriminated for atherosclerotic cardiovascular disease (ASCVD) risk (AUC = 0.892, 95% CI: 0.846– 0.938) compared to visceral adiposity index (VAI) (0.559, 95% CI: 0.439–0.679)
Summary
It is well known that abdominal visceral fat is related to insulin resistance regardless of body mass index (BMI). Abdominal visceral fat has a stronger association with a risk of cardiovascular [3, 5, 8] and cerebrovascular disease compared with other anthropometric measures (e.g. BMI, total fat, and waist circumference [WC]) [9,10,11]. Computed tomography (CT) and magnetic resonance imaging (MRI) precisely and reliably quantify individual differences in abdominal fat distribution and distinguish visceral adipose tissue from subcutaneous adiposity, but both methods are expensive and CT has a high risk of radiation exposure [12]. Amato et al established the visceral adiposity index (VAI) model that was based on a Caucasian population; this multivariate model includes non-invasive, simple parameters (WC, BMI, serum triglycerides [TG], and high-density lipoprotein [HDL] cholesterol levels) to incorporate functionality in deriving a measure of dysfunctional adipose tissue that is not directly visceral adiposity [13]. The application of the VAI to non-Caucasian populations is limited, and there is little data regarding the Korean population
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