Key result
Lower visceral fat area links to ~15% lower arterial stiffness risk, outperforming BMI in T2D.
Why the study?
The obesity paradox occurs in T2DM patients when BMI defines obesity, prompting evaluation of visceral fat area as an obesity metric associated with arterial stiffness across ideal cardiovascular health metrics.
Is visceral fat area more strongly associated with arterial stiffness than BMI in patients with T2DM?
Observational (n=29,048)
Yes
Is visceral fat area more strongly associated with arterial stiffness than BMI in patients with T2DM?
Effect estimate: OR 0.85 (95% CI 0.80-0.90)
In patients with T2DM, visceral fat area is a better anthropometric measure of cardiovascular risk (arterial stiffness) than BMI.
Visceral fat area may better indicate arterial stiffness risk than BMI in T2DM; hypothesis-generating and should not yet change practice.
Background “Obesity paradox” occurs in type 2 diabetes mellitus (T2DM) patients when body mass index (BMI) is applied to define obesity. We examined the association of visceral fat area (VFA) as an obesity measurement with arterial stiffness in seven ideal cardiovascular health metrics (ICVHMs). Methods A total of 29 048 patients were included in the analysis from June 2017 to April 2021 in 10 sites of National Metabolic Management Centers. ICVHMs were modified from the recommendations of the American Heart Association. Brachial‐ankle pulse wave velocity (BaPWV) ≥ 1400 cm/s was employed to evaluate increased arterial stiffness. Multivariate regression models were used to compare the different effects of BMI and VFA on arterial stiffness. Results Lower VFA was more strongly associated with low BaPWV than lower BMI when other ICVHMs were included (adjusted odds ratio [OR], 0.85 [95% confidence interval [CI], 0.80–0.90] vs OR 1.08 [95% CI, 1.00–1.17]). Multivariable‐adjusted ORs for arterial stiffness were highest in patients with the VAT area VFA in the range of 150‐200 cm 2 (adjusted OR, 1.26 [95% CI 1.12–1.41]). Compared with participants with VAT VFA < 100 cm 2 , among participants with higher VAT VFA, the OR for arterial stiffness decreased gradually from 1.89 (95% CI, 1.73–2.07) in patients who had ≤1 ICVHM to 0.39 (95% CI, 0.25–0.62) in patients who had ≥5 ICVHMs. Conclusion In patients with T2DM, using VAT for anthropometric measures of obesity, VFA was more relevant to cardiovascular risk than BMI in the seven ICVHMs. For anthropometric measures of obesity in the ICVHMs to describe cardiovascular risk VFA would be more optimal than BMI.
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Zhao et al. (2023) conducted an observational in Type 2 diabetes mellitus (T2DM) (n=29,048). Visceral fat area (VFA) vs. Body mass index (BMI) was evaluated on Increased arterial stiffness (BaPWV ≥ 1400 cm/s) (OR 0.85, 95% CI 0.80-0.90). Lower visceral fat area was more strongly associated with reduced arterial stiffness than lower BMI in patients with type 2 diabetes (OR 0.85; 95% CI 0.80-0.90).
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