Use of the Visceral Adiposity Index as an Indicator of Chronic Kidney Disease in Older Adults: Comparison with Body Mass Index

Abstract

The visceral adiposity index (VAI) was recently introduced to quantify visceral fat accumulation and dysfunction. This cross-sectional study explored whether the VAI is associated with chronic kidney disease (CKD) in older adults and compared its utility with that of body mass index (BMI) for predicting CKD. In total, 7736 older adults (3479 men and 4257 women) aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups. Associations of the VAI and BMI with CKD were compared among the groups, and cut-off points for moderate-to-severe CKD (^MSCKD) were established. While the VAI could discriminate among all of the groups, the BMI could not. The severity of CKD was more strongly associated with the VAI than BMI. The odds ratios indicated that, in the fully adjusted model, the VAI was a significant predictor of ^MSCKD in both men and women, while the BMI was a significant predictor only in men. For the VAI, the area under the receiver operating characteristic curve values for men and women were 0.631 (cut-off point: ≥2.993) and 0.588 (≥4.001), compared with 0.555 (≥25.335) and 0.533 (≥24.096) for BMI, respectively. Taken together, the findings suggest that the VAI is associated with CKD and represents a better indicator for the disease than BMI.

Keywords: body mass index; chronic kidney disease; older adults; visceral adiposity index.

Figure 1

Flow chart of study subjects.

Figure 2

Sex-specific differences and trends in the VAI and BMI according to eGFR category. Values are mean ± 95 confidence interval. A = eGFR ≥ 60 (95% CI); B = eGFR 45–59.9 (95% CI); C = eGFR < 45; VAI = visceral adiposity index; BMI = body mass index; SS = standardized statistic. ** p < 0.01 for the difference between groups.

Figure 3

Sex-specific odds ratios for the relationships of ^MSCKD with the VAI and BMI Z-scores. Dotted line: reference; solid line: 95% confidence interval; Black circle: odds ratio. * p < 0.05, ** p < 0.01, *** p < 0.001 for the odds ratios for ^MSCKD, compared with the lowest tertiles. Abbreviations: HT, highest tertile; MT, middle tertile. VAI = visceral adiposity index; BMI = body mass index.

Figure 4

The ROC curves of the VAI and BMI plotted against ^MSCKD for each sex. Thin black line: reference; solid red line: area under the curve (AUC), indicating the accuracy of the VAI for the identification of ^MSCKD; thin dotted blue line: area under the curve (AUC), indicating the accuracy of the BMI for the identification of ^MSCKD; cut-off point: the value of VAI or BMI that predicts ^MSCKD; sensitivity: the probability of individuals who actually have ^MSCKD to be predicted to have ^MSCKD; specificity: the probability of individuals who do not have ^MSCKD to be predicted not to have ^MSCKD. Abbreviation: VAI = visceral adiposity index; BMI = body mass index; AUC = area under curve.