What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes (n=8948). Intervention: Visceral adiposity index (VAI) vs. Per-standard deviation increase. Primary outcome: Incident diabetic nephropathy (HR 1.127, 95% CI 1.050-1.210, p=0.001).

February 24, 2022Cardiovascular Diabetology78 citationsOpen Access

Association of visceral adiposity index with incident nephropathy and retinopathy: a cohort study in the diabetic population

ZWZhiyuan WuGoethe University Frankfurt SYSiqi YuChina Pharmaceutical University XKXiaoping KangAcademy of Military Medical Sciences

Key Result

A one-standard deviation increase in visceral adiposity index was significantly associated with an increased risk of incident nephropathy (HR 1.127) in Chinese adults with type 2 diabetes.

Study Design

Type

Cohort (n=8,948)

Multicenter

Yes

Structured PICO

Is visceral adiposity index associated with incident nephropathy and retinopathy in adults with type 2 diabetes?

Population

8,948 Chinese adults aged 20 years or older with type 2 diabetes, free of baseline nephropathy and retinopathy, followed for a median of 4.82 years.

Exposure

Visceral adiposity index (VAI) and Chinese VAI (CVAI) levels (evaluated per 1-SD increase)

Outcome

Incidence of diabetic nephropathy (confirmed by urine albumin/creatinine ratio and eGFR) and retinopathy (diagnosed using fundus photograph)hard clinical

Visceral adiposity index is an independent predictor of incident diabetic nephropathy, but not retinopathy, in Chinese adults with type 2 diabetes.

Main Result

Hazard Ratio: 1.127 (95% CI 1.05–1.21)

p-value: p=0.001

Limitations

Visceral adiposity was not directly measured by MRI, and the consistence between actual visceral fat mass and VAI in the Chinese population was not examined.
The exact duration of diabetes in this cohort was unavailable, which could bias the relationship between VAI and diabetic nephropathy.
Information about neurological complications was unavailable, preventing assessment of the longitudinal association between VAI and neuropathy development.

Abstract

BACKGROUND: The association between visceral adiposity index (VAI) and diabetic complications has been reported in cross-sectional studies, while the effect of VAI on complication development remains unclear. This study aims to evaluate the longitudinal association of VAI and Chinese VAI (CVAI) with the incidence of diabetic nephropathy and retinopathy using a Chinese cohort. METHODS: A total of 8 948 participants with type 2 diabetes from Beijing Health Management Cohort were enrolled during 2013-2014, and followed until December 31, 2019. Nephropathy was confirmed by urine albumin/creatinine ratio and estimated glomerular filtration rate; retinopathy was diagnosed using fundus photograph. RESULTS: The mean (SD) age was 53.35 (14.66) years, and 6 154 (68.8%) were men. During a median follow-up of 4.82 years, 467 participants developed nephropathy and 90 participants developed retinopathy. One-SD increase in VAI and CVAI levels were significantly associated with an increased risk of nephropathy, and the adjusted hazard ratios (HR) were 1.127 (95% CI 1.050-1.210) and 1.165 (95% CI 1.003-1.353), respectively. On contrary, VAI and CVAI level were not associated with retinopathy after adjusting confounding factors. CONCLUSION: VAI and CVAI are independently associated with the development of nephropathy, but not retinopathy in Chinese adults with diabetes.

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