Waist-height ratio and waist are the best estimators of visceral fat in type 1 diabetes

Erika B Parente,Valma Harjutsalo,Aila J Ahola,Carol Forsblom,Per-Henrik Groop,Stefan Mutter

doi:10.1038/s41598-020-75667-5

Erika B Parente, Valma Harjutsalo + Show 4 more

Open Access

https://doi.org/10.1038/s41598-020-75667-5

Copy DOI

Abstract

Visceral fat is associated with cardiovascular and kidney disease. However, the relationship between body composition and anthropometric measures in type 1 diabetes is unknown. Using z-statistics, we ranked the ability of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), waist-height ratio (WHtR) and a body shape index (ABSI) to capture measures of body composition from 603 Dual-energy-X-Ray-Absorptiometry scans of adults with type 1 diabetes. Albuminuria was defined as urinary albumin excretion rate of at least 30 mg/24 h. Women with albuminuria had higher visceral fat mass % (VFM%) (0.9 vs. 0.5%, p = 0.0017) and lower appendicular lean mass % (AppLM%) (25.4 vs 26.4%, p = 0.03) than those without. Men with albuminuria had higher VFM% (1.5 vs. 1.0%, p = 0.0013) and lower AppLM% (30.0 vs 32.3, p < 0.0001) than those without. In men, WHtR estimated VFM% best (z-statistics = 21.1), followed by WC (z = 19.6), BMI (z = 15.1), WHR (z = 14.6) and ABSI (z = 10.1). In women, the ranking was WC (z = 28.9), WHtR (z = 27.3), BMI (z = 20.5), WHR (z = 12.7) and ABSI (z = 10.5). Overall, the ranking was independent of albuminuria. Adults with type 1 diabetes and albuminuria have greater VFM% and lower AppLM% than those without. WHtR and WC best estimate the VFM% in this population, independently of albuminuria and sex.

Highlights

IntroductionAbbreviations AFM Android fat mass AFM% AFM/total body weight × 100 AppLM Appendicular-lean-mass (both legs and arms lean mass) AppLM% AppLM/total body-weight × 100 BFM Body fat mass BFM% BFM/total body weight × 100 BLM Body lean mass BLM% BLM/total body weight × 100 body mass index (BMI) Body mass index diabetic nephropathy (DN) Diabetic nephropathy DXA Dual-energy X-ray Absorptiometry HDL High-density lipoprotein cholesterol VFM Visceral fat mass VFM% VFM/total body weight × 100 waist circumference (WC) Waist circumference waist-hip ratio (WHR) Waist-hip-ratio waist-height ratio (WHtR) Waist-height ratio
Abbreviations AFM Android fat mass AFM% AFM/total body weight × 100 AppLM Appendicular-lean-mass AppLM% AppLM/total body-weight × 100 BFM Body fat mass BFM% BFM/total body weight × 100 BLM Body lean mass BLM% BLM/total body weight × 100 body mass index (BMI) Body mass index diabetic nephropathy (DN) Diabetic nephropathy DXA Dual-energy X-ray Absorptiometry HDL High-density lipoprotein cholesterol VFM Visceral fat mass VFM% VFM/total body weight × 100 waist circumference (WC) Waist circumference waist-hip ratio (WHR) Waist-hip-ratio waist-height ratio (WHtR) Waist-height ratio
Given that obesity is causally related to diabetic nephropathy (DN) in individuals with type 1 d iabetes[9], it would be of utmost importance to understand how the anthropometric measures are related to their body composition and especially visceral fat, which has been associated with dyslipidemia, insulin resistance, CVD8,10, and chronic kidney disease[11,12] in the general population

Summary

Introduction

Abbreviations AFM Android fat mass AFM% AFM/total body weight × 100 AppLM Appendicular-lean-mass (both legs and arms lean mass) AppLM% AppLM/total body-weight × 100 BFM Body fat mass BFM% BFM/total body weight × 100 BLM Body lean mass BLM% BLM/total body weight × 100 BMI Body mass index DN Diabetic nephropathy DXA Dual-energy X-ray Absorptiometry HDL High-density lipoprotein cholesterol VFM Visceral fat mass VFM% VFM/total body weight × 100 WC Waist circumference WHR Waist-hip-ratio WHtR Waist-height ratio. Previous research from our group showed that the mortality rate of individuals with type 1 diabetes increases starting from a body mass index (BMI) of 24.8 kg/m2, which is still within the normal r ange[1]. Anthropometric measures such as waist circumference (WC) and waist-hip ratio (WHR) are accessible and of low cost, they have certain limitations[13] Another practical anthropometric measure is the waist-height ratio (WHtR) that has been associated with CVD in the general population and has the advantage to have a unisex cut-off value of 0.513–16, a meta-analysis has shown that WHtR is a better screening tool than WC and BMI for adult cardiometabolic risk factors[16]. A body shape index (ABSI) is another formula in which WC is adjusted for weight and height and has been a predictor of mortality, independently of BMI, in an American population from the National Health and Nutrition Examination Survey (NHANES)[17]

Objectives

Methods

Results

Conclusion