Associations between abdominal obesity indices and diabetic complications: Chinese visceral adiposity index and neck circumference

Abstract

Background and aims: Obesity, especially abdominal obesity, has been considered a risk factor for diabetic complications. Many abdominal obesity indices have been established, including neck circumference (NC), waist-to-hip ratio (WHR), lipid accumulation product (LAP), visceral adiposity index (VAI) and the Chinese visceral adiposity index (CVAI). However, studies investigating the associations between these indices and diabetic complications are limited. The objective of this study was to investigate the associations of the abdominal obesity indices with cardiovascular and cerebrovascular disease (CVD), diabetic kidney disease (DKD) and diabetic retinopathy (DR).

Methods: A total of 4658 diabetic participants were enrolled from seven communities in Shanghai, China, in 2018. Participants completed questionnaires and underwent blood pressure, glucose, lipid profile, and urine albumin/creatinine ratio measurements; fundus photographs; and anthropometric parameters, including height, weight, waist circumference (WC), NC and hip circumference (HC).

Results: In men, a one standard deviation (SD) increase in CVAI level was significantly associated with a greater prevalence of CVD (OR 1.35; 95% CI 1.13, 1.62) and DKD (OR 1.38; 95% CI 1.12, 1.70) (both P < 0.05). In women, a one SD increase in CVAI level was significantly associated with a greater prevalence of CVD (OR 1.32; 95% CI 1.04, 1.69) and DKD (OR 2.50; 95% CI 1.81, 3.47) (both P < 0.05). A one SD increase in NC was significantly associated with a greater prevalence of CCA plaque in both men (OR 1.26; 95% CI 1.10, 1.44) and women (OR 1.20; 95% CI 1.07, 1.35). These associations were all adjusted for potential confounding factors.

Conclusions: CVAI was most strongly associated with the prevalence of CVD and DKD among the abdominal obesity indices, and NC was unique associated with the prevalence of CCA plaque in Chinese adults with diabetes. Trial registration ChiCTR1800017573, www.chictr.org.cn . Registered 04 August 2018.

Keywords: Abdominal obesity; Cardiovascular and cerebrovascular disease; Chinese visceral adiposity index; Diabetic complications; Diabetic kidney disease; Neck circumference.

Fig. 1

Associations between abdominal obesity indices and the prevalence of CVD. a Associations between abdominal obesity indices and the prevalence of CVD. b Associations between abdominal obesity indices and the prevalence of CCA plaque. Logistic regression analyses were used for the association of abdominal obesity indices with the prevalence of CVD and CCA plaque. The model was adjusted for age, education, duration of diabetes, current smoking, BMI, HbA1c, LDL and systolic blood pressure. CVD cardiovascular and cerebrovascular disease, CCA common carotid artery, BMI body mass index, HbA1c glycated hemoglobin, NC neck circumference, VAI visceral adiposity index, LAP the lipid accumulation product, WC waist circumference, CVAI Chinese visceral adiposity index, WHR waist-to-hip ratio, LDL low-density lipoprotein

Fig. 2

Associations between abdominal obesity indices and the prevalence of DKD. a Associations between abdominal obesity indices and the prevalence of DKD. b Associations between abdominal obesity indices and Ln ACR level. c Associations between abdominal obesity indices and eGFR level. Logistic regression analyses were used for the association of the abdominal obesity index with DKD. Linear regression analysis was used for the associations of the abdominal obesity index with Ln ACR and eGFR, respectively. ¹The model was adjusted for age, education, duration of diabetes, current smoking, BMI, HbA1c, LDL and systolic blood pressure. ²The model was adjusted for education, duration of diabetes, current smoking, BMI, HbA1c, LDL and systolic blood pressure. Ln ACR log-transformed albumin to creatinine ratio; eGFR estimated glomerular filtration rate, DKD diabetic kidney disease, BMI body mass index, HbA1c glycated hemoglobin, NC neck circumference, VAI visceral adiposity index, LAP the lipid accumulation product, WC waist circumference, CVAI Chinese visceral adiposity index, WHR waist-to-hip ratio, LDL low-density lipoprotein

Fig. 3

Associations between abdominal obesity indices and the prevalence of DR. Logistic regression analyses were used for the association between the abdominal obesity index and the prevalence of DR. The model was adjusted for age, sex, education, duration of diabetes, current smoking, BMI, HbA1c, LDL and systolic blood pressure. DR diabetic retinopathy, BMI body mass index, HbA1c glycated hemoglobin, NC neck circumference, VAI visceral adiposity index, LAP the lipid accumulation product, WC waist circumference, CVAI Chinese visceral adiposity index, WHR waist-to-hip ratio, LDL low-density lipoprotein

Fig. 4

ROC curve of abdominal obesity indices for diagnosing CVD and DKD in men and women. a The ROC curve of abdominal obesity indices for diagnosing CVD in men. b The ROC curve of abdominal obesity indices for diagnosing CVD in women. c The ROC curve of abdominal obesity indices for diagnosing DKD in men. d The ROC curve of abdominal obesity indices for diagnosing DKD in women. ROC Receiver operating characteristic, CVD cardiovascular and cerebrovascular disease, DKD diabetic kidney disease, NC neck circumference, VAI visceral adiposity index, LAP lipid accumulation product, WC waist circumference, CVAI Chinese visceral adiposity index, WHR waist-to-hip ratio, BMI body mass index