Association of Visceral Adiposity, Core Skeletal Muscle Mass, Atherogenic Index of Plasma, and Renal Function (CKD-EPI) with Framingham Cardiovascular Risk Score in Adults: A Cross-Sectional Study

Q: What are the key findings of this study?

Visceral adiposity strongly associated with Atherogenic Index of Plasma (β = 0.339), which in turn correlated with the Framingham Cardiovascular Risk Score (β = 0.389) in adults.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular risk in general adult population (n=520). Intervention: Visceral adiposity, Core Skeletal Muscle Mass (CSMM), Atherogenic Index of Plasma (AIP), and renal function (CKD-EPI eGFR). Primary outcome: Framingham Cardiovascular Risk Score (FRS) (β = 0.389 (AIP to FRS); β = 0.339 (visceral adiposity to AIP); β = -0.070 (CSMM to AIP); β = -0.080 (CKD-EPI to FRS), p=<0.05).

Q: What does this research mean for the field?

Visceral adiposity is positively associated with the Atherogenic Index of Plasma, which significantly mediates an increased Framingham Cardiovascular Risk Score in adults. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the associations of visceral adiposity, core skeletal muscle mass, atherogenic index of plasma, and CKD-EPI-assessed renal function with the Framingham Cardiovascular Risk Score in adults.

Nathanael Ryan Hansel Wijaya; Ronald Winardi Kartika; Andria Priyana; Yohanes Firmansyah

doi:10.30701/ijc.2103

October 25, 2026Indonesian Journal of CardiologyOpen Access

Association of Visceral Adiposity, Core Skeletal Muscle Mass, Atherogenic Index of Plasma, and Renal Function (CKD-EPI) with Framingham Cardiovascular Risk Score in Adults: A Cross-Sectional Study

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Key result

Visceral adiposity correlates with higher cardiovascular risk via atherogenic dyslipidemia in adults.

β = 0.389 (AIP to FRS); β = 0.339 (visceral adiposity to AIP); β = -0.070 (CSMM to AIP); β = -0.080 (CKD-EPI to FRS)
P<0.05
n=520

Why the study?

Cardiovascular risk prediction increasingly incorporates markers of adiposity, muscle composition, and metabolic function, motivating an evaluation of the interrelated contributions of visceral adiposity, Core Skeletal Muscle Mass (CSMM), Atherogenic Index of Plasma (AIP), and renal function (CKD-EPI) to the Framingham Cardiovascular Risk Score (FRS).

Key Points

To examine the associations of visceral adiposity, core skeletal muscle mass, atherogenic index of plasma, and CKD-EPI-assessed renal function with the Framingham Cardiovascular Risk Score in adults.
Conducted a cross-sectional study in 520 adults aged 30–75 years (mean age 49.33 ± 11.47 years; 74.4% female).
Measured visceral adiposity, core skeletal muscle mass (CSMM), atherogenic index of plasma (AIP), and renal function via the CKD-EPI equation alongside the Framingham Cardiovascular Risk Score (FRS).
Applied path analysis using partial least squares structural equation modeling (SmartPLS) to evaluate direct and indirect associations.
Visceral adiposity showed a strong positive association with AIP (β = 0.339), whereas CSMM showed an inverse relationship with AIP (β = −0.070).
AIP correlated positively with both CKD-EPI (β = 0.030) and the FRS (β = 0.389), while CKD-EPI demonstrated a modest negative association with the FRS (β = −0.080).
The path model explained 10.8% of the variance in AIP (R² = 0.108), 0.1% in CKD-EPI (R² = 0.001), and 15.6% in cardiovascular risk (R² = 0.156).

Study Design

Type

Cross-Sectional (n=520)

Multicenter

Yes

Structured PICO

P

Population

520 community-dwelling Indonesian adults (mean age 49.33 years, 74.4% female) free of lipid-lowering therapy or chronic conditions affecting lipid/renal parameters, evaluated cross-sectionally across three regions between August and December 2025.

E

Exposure

Assessment of visceral adiposity and Core Skeletal Muscle Mass (CSMM) via bioelectrical impedance analysis, Atherogenic Index of Plasma (AIP) via fasting lipid profile [log(TG/HDL-C)], and renal function via CKD-EPI equation

O

Outcome

Framingham Cardiovascular Risk Score (FRS) estimating 10-year CVD risksurrogate

Main Result

Effect estimate: β = 0.389 (AIP to FRS); β = 0.339 (visceral adiposity to AIP); β = -0.070 (CSMM to AIP); β = -0.080 (CKD-EPI to FRS)

p-value: p=<0.05

Visceral adiposity and the Atherogenic Index of Plasma are key linked mediators of elevated Framingham Cardiovascular Risk Scores in Indonesian adults, while skeletal muscle mass and renal function act as minor secondary modulators.

Limitations

Cross-sectional design precludes establishing causal or temporal relationships.
Predominantly female sample (74.4%) recruited via purposive sampling and lack of sex-specific analyses limit generalizability.
Potential confounding factors such as diet, physical activity, medication use, and socioeconomic status were not fully controlled.
Visceral fat and muscle mass were assessed via single time-point bioelectrical impedance analysis rather than advanced imaging.
Mathematical coupling and conceptual overlap between AIP and Framingham Risk Score due to shared HDL-C component may inflate observed associations.
Framingham Risk Score was developed in a Western cohort and may not be optimally calibrated for the Indonesian population.
Relatively preserved kidney function in the cohort may have limited the ability to detect stronger associations between eGFR and cardiovascular risk.
Cross-sectional design prevents establishing causal relationships or temporal sequence
Study population and sample size may limit the generalizability of the findings
Potential conceptual and mathematical overlap (circularity) between AIP and FRS due to shared lipid parameters (HDL-C)
Complementary analyses using conventional regression models and sensitivity analyses to minimize mathematical dependency were not performed

Implication

Supports exploring visceral adiposity and AIP in CV risk assessment; leaves open causal inference and practice change due to cross-sectional design.

Abstract

Background: Cardiovascular risk prediction increasingly incorporates markers of adiposity, muscle composition, and metabolic function. This study examined the associations among visceral adiposity, Core Skeletal Muscle Mass (CSMM), Atherogenic Index of Plasma (AIP), and renal function assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in relation to the Framingham Cardiovascular Risk Score (FRS) in adults, aiming to elucidate their interrelated contributions to Cardiovascular Disease (CVD) prevention. Methods: A cross-sectional study was conducted among 520 adults aged 30–75 years. Visceral adiposity, CSMM, AIP, and CKD-EPI were measured and analyzed alongside FRS. Path analysis using SmartPLS assessed direct and indirect associations. The sample size and analytical framework followed current epidemiological standards for body composition indices and risk prediction models. Results: Visceral adiposity demonstrated a strong positive association with AIP (? = 0.339), which in turn correlated with both CKD-EPI (? = 0.030) and the FRS (? = 0.389). CSMM was inversely related to AIP (? = ?0.070), suggesting a protective effect, while CKD-EPI showed a modest negative association with the FRS (? = ?0.080). The overall model indicated that visceral adiposity and AIP are key mediators in cardiovascular risk estimation among adults. Conclusions: Visceral adiposity and AIP are significantly linked to cardiovascular risk as quantified by the FRS, with renal function and skeletal muscle mass serving as secondary modulators. These findings highlight the importance of integrating adiposity and metabolic markers into CVD risk stratification, supporting tailored preventive strategies in clinical practice.

Discussion

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Cite This Study

Wijaya et al. (2026) conducted a cross-sectional in Cardiovascular risk in general adult population (n=520). Visceral adiposity, Core Skeletal Muscle Mass (CSMM), Atherogenic Index of Plasma (AIP), and renal function (CKD-EPI eGFR) was evaluated on Framingham Cardiovascular Risk Score (FRS) (β = 0.389 (AIP to FRS); β = 0.339 (visceral adiposity to AIP); β = -0.070 (CSMM to AIP); β = -0.080 (CKD-EPI to FRS), p=<0.05). Visceral adiposity strongly associated with Atherogenic Index of Plasma (β = 0.339), which in turn correlated with the Framingham Cardiovascular Risk Score (β = 0.389) in adults.

synapsesocial.com/papers/6ae28f09cbadf70daf6c43fb https://doi.org/10.30701/ijc.2103

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Association of Visceral Adiposity, Core Skeletal Muscle Mass, Atherogenic Index of Plasma, and Renal Function (CKD-EPI) with Framingham Cardiovascular Risk Score in Adults: A Cross-Sectional Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association of Visceral Adiposity, Core Skeletal Muscle Mass, Atherogenic Index of Plasma, and Renal Function (CKD-EPI) with Framingham Cardiovascular Risk Score in Adults: A Cross-Sectional Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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