In adults with type 2 diabetes, the highest quartile of visceral-to-subcutaneous fat ratio was associated with a 0.562 mmol/L higher residual cholesterol compared to the lowest quartile.
Cross-Sectional (n=1,135)
No
Are visceral fat area and visceral-to-subcutaneous fat ratio more strongly associated with residual cholesterol than conventional anthropometric indices in adults with type 2 diabetes?
Visceral fat area and visceral-to-subcutaneous fat ratio are more strongly associated with residual cholesterol than traditional anthropometric measures in type 2 diabetes, suggesting they may better capture residual cardiovascular risk.
Mean Difference: 0.562 (95% CI 0.316–0.808)
p-value: p=<0.00001
Background: Residual cholesterol (RC) is linked to cardiovascular risk, yet the optimal adiposity indices to capture this burden in type 2 diabetes (T2D) remain unclear. We compared associations of general and central adiposity indices with RC in a real-world T2D cohort. Methods: This cross-sectional study included 1,135 adults with T2D at a Chinese Metabolic Management Centre (2022-2025). We assessed BMI, weight, waist circumference (WC), waist-to-height ratio (WHtR), visceral fat area (VFA), subcutaneous fat area (SFA), and VFA/SFA ratio. Linear regression estimated β coefficients for RC per 1-SD increase in indices, adjusted for age, sex, HbA1c, eGFR, blood pressure, smoking, and drinking. Nonlinearity was assessed using generalized additive models and piecewise regression. Results: Across RC quartiles, patients with higher RC were more often male and current smokers and had higher BMI, WC, VFA, SFA, WHtR and VFA/SFA. In unadjusted models, all adiposity indices were positively associated with RC, but after full adjustment only VFA (β 0.1102, 95% CI 0.0186-0.2018) and VFA/SFA (β 0.1882, 95% CI 0.1010-0.2753) remained independently related to RC. When modelled in original units and quartiles, the highest VFA quartile was associated with 0.383 mmol/L (95% CI 0.131-0.636) higher RC and the highest VFA/SFA quartile with 0.562 mmol/L (95% CI 0.316-0.808) higher RC compared with the lowest quartile in fully adjusted models. A non-linear association between VFA/SFA and RC was observed, with an inflection around 0.72: below this threshold, higher VFA/SFA was strongly associated with higher RC (β 1.61, 95% CI 0.91-2.30), whereas no clear association was seen above it. Subgroup analyses showed broadly consistent associations across age, sex, BMI and HbA1c strata, without significant interactions. Conclusions: In T2D, indices of visceral fat accumulation-particularly VFA and VFA/SFA-are more strongly associated with RC than BMI, WC, or WHtR. A VFA/SFA ratio near 0.7-0.8 may mark a critical range where visceral fat predominance is most strongly linked to RC elevation. Detailed visceral adiposity assessment may help refine RC-related risk stratification beyond traditional measures.
Rao et al. (Fri,) conducted a cross-sectional in Type 2 diabetes (n=1,135). Visceral-to-subcutaneous fat ratio (VFA/SFA) vs. Lowest quartile of VFA/SFA was evaluated on Residual cholesterol (RC) (MD 0.562, 95% CI 0.316-0.808, p=<0.00001). In adults with type 2 diabetes, the highest quartile of visceral-to-subcutaneous fat ratio was associated with a 0.562 mmol/L higher residual cholesterol compared to the lowest quartile.