Abstract
BackgroundThis study assessed the performance of visceral adiposity index and body shape index in predicting diabetes mellitus (DM) risk and compared their predictive ability to that of body mass index and waist circumference.MethodsAmong 8249 consecutive subjects who attended the Nationwide Health Check Up System for Senior Citizens (≥ 65 years) between 2008 and 2018, we examined the associations of several adiposity indices with DM risk and explored gender differences.ResultsAmong all adiposity indicators, Chinese visceral adiposity index (CVAI) demonstrated the highest discriminatory ability for diabetes mellitus with area under receiver operating characteristic curves (AUC) of 0.65, 0.68, and 0.66 for men, women, and all participants, respectively, and optimal cut-offs set as 126.09 in men and 117.77 in women. Compared with body shape index (ABSI), both CVAI and VAI were strongly associated with baseline DM (adjusted OR: 4.85, 95% CI: 4.05–5.82 and 4.22, 95% CI: 3.53–5.05 for 4th vs 1st quartile groups by CVAI and VAI, P < 0.001), which was more pronounced in older adult women (Pinteraction < 0.05). Over a median of 5.25 years (IQR: 3.07–6.44 years) follow-up, Cox regression models showed higher predictive ability of CVAI and VAI compared to ABSI. Further, both CVAI and VAI independently predicted new-onset DM (adjusted HR: 1.29, 95% CI: 1.22–1.37 and 1.16, 95% CI: 1.11–1.21 by CVAI and VAI) and composite endpoint of new DM and death among those without baseline DM.ConclusionsOur population-based data demonstrated that Chinese visceral adiposity index may serve as a superior clinical indicator of diabetes when compared with conventional anthropometric indices among older adult Chinese, especially in women.
Highlights
A higher prevalence of diabetes mellitus in the older adult population is a critical public health issue worldwide [1]
Diabetes in older adult populations can result due to genetic background and/or longer life expectancy that leads to decreased insulin secretion or higher insulin resistance, which can result from multiple factors such as central obesity or metabolic syndrome mediated by excessive visceral adipose tissue (VAT) accumulation [2, 3]
Baseline characteristics of the study population The mean age among the 8249 study participants was 74.1 ± 7.1, and 56.4% (n = 4649) of the subjects were women (Table 1). In both genders significant dose– response relationships were observed between higher Chinese visceral adiposity index (CVAI) and advanced age, larger anthropometric indices (i.e., body mass index (BMI), waist circumference (WC)), increased blood pressure, increased fasting glucose, elevated uric acid (UA) level, more unfavorable high-density lipoprotein cholesterol (HDL-C)/ TG profiles, and worsened renal function (P < 0.001)
Summary
A higher prevalence of diabetes mellitus in the older adult population is a critical public health issue worldwide [1]. With a prevalence that is high in older adult populations, diabetes mellitus can cause systemic organ damage and lead to cardiovascular diseases. Diabetes in older adult populations can result due to genetic background and/or longer life expectancy that leads to decreased insulin secretion or higher insulin resistance, which can result from multiple factors such as central obesity or metabolic syndrome mediated by excessive visceral adipose tissue (VAT) accumulation [2, 3]. Aging may trigger adverse pro-inflammatory cytokine secretions through visceral fat redistribution, leading to metabolic disorders, such as diabetes mellitus [4]. This study assessed the performance of visceral adiposity index and body shape index in predicting diabetes mellitus (DM) risk and compared their predictive ability to that of body mass index and waist circumference
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