Surrogate markers of visceral adiposity in young adults: waist circumference and body mass index are more accurate than waist hip ratio, model of adipose distribution and visceral adiposity index.

Susana Borruel,Elena Fernández-Durán,Macarena Alpañés,Manuel Luque-Ramírez,José F Moltó,Héctor F Escobar-Morreale,Francisco Álvarez-Blasco,Michael Müller

doi:10.1371/journal.pone.0114112

Abstract

Surrogate indexes of visceral adiposity, a major risk factor for metabolic and cardiovascular disorders, are routinely used in clinical practice because objective measurements of visceral adiposity are expensive, may involve exposure to radiation, and their availability is limited. We compared several surrogate indexes of visceral adiposity with ultrasound assessment of subcutaneous and visceral adipose tissue depots in 99 young Caucasian adults, including 20 women without androgen excess, 53 women with polycystic ovary syndrome, and 26 men. Obesity was present in 7, 21, and 7 subjects, respectively. We obtained body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), model of adipose distribution (MOAD), visceral adiposity index (VAI), and ultrasound measurements of subcutaneous and visceral adipose tissue depots and hepatic steatosis. WC and BMI showed the strongest correlations with ultrasound measurements of visceral adiposity. Only WHR correlated with sex hormones. Linear stepwise regression models including VAI were only slightly stronger than models including BMI or WC in explaining the variability in the insulin sensitivity index (yet BMI and WC had higher individual standardized coefficients of regression), and these models were superior to those including WHR and MOAD. WC showed 0.94 (95% confidence interval 0.88–0.99) and BMI showed 0.91 (0.85–0.98) probability of identifying the presence of hepatic steatosis according to receiver operating characteristic curve analysis. In conclusion, WC and BMI not only the simplest to obtain, but are also the most accurate surrogate markers of visceral adiposity in young adults, and are good indicators of insulin resistance and powerful predictors of the presence of hepatic steatosis.

Highlights

Visceral adiposity is associated with cardiovascular and metabolic disorders [1] including insulin resistance [2], low-grade chronic inflammation [3], type 2 diabetes [4], dyslipidemia [5], polycystic ovary syndrome (PCOS) [6], male hypogonadism [7], nonalcoholic fatty liver disease [8], hypertension [9] and several cancers [10]
We aimed to evaluate Waist circumference (WC), waist-hip ratio (WHR), model of adipose distribution (MOAD) and visceral adiposity index (VAI) as surrogate indexes of visceral adiposity, objectively assessed by ultrasound examination in young adults including healthy women, women with PCOS, and healthy men, presenting with or without obesity
The methods and assays used to diagnose in the patients and to exclude hyperandrogenic disorders in healthy women have been described in detail elsewhere [23, 28, 29] and, besides extensive hormonal testing, included a standard 2-h 75 g oral glucose tolerance test that permitted the calculation of the composite insulin sensitivity index from glucose and insulin concentrations [30]

Summary

Introduction

Visceral adiposity is associated with cardiovascular and metabolic disorders [1] including insulin resistance [2], low-grade chronic inflammation [3], type 2 diabetes [4], dyslipidemia [5], polycystic ovary syndrome (PCOS) [6], male hypogonadism [7], nonalcoholic fatty liver disease [8], hypertension [9] and several cancers [10]. Amelioration of visceral adiposity is of importance for the prevention and management of most of these disorders [11]. Imaging techniques are frequently substituted by surrogate indexes of visceral adiposity. Waist circumference (WC) and waist-hip ratio (WHR) are the most commonly used surrogate indexes of visceral adiposity. Increased WC is a requisite for the diagnosis of the metabolic syndrome according to the International Diabetes Federation [13]

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Conclusion