Association of obesity- and insulin resistance-related indices with subclinical carotid atherosclerosis in type 1 diabetes: a cross-sectional study

Abstract

Background: Obesity and insulin resistance are well-established risk factors for atherosclerosis and cardiovascular disease (CVD). Although some obesity- and insulin resistance-related indices (OIRIs) have been linked to CVD, their associations with subclinical carotid atherosclerosis (SCA) in individuals with type 1 diabetes (T1D) remain unclear. This study aims to systematically explore and compare the associations of various common OIRIs with SCA in T1D population.

Methods: A total of 418 adult inpatients with classic T1D admitted from October 2008 to June 2021 to the First Affiliated Hospital of Air Force Medical University in Xi'an, China were included in this study. Demographic, anthropometric, and laboratory data were collected. Studied OIRIs comprised body mass index, waist-to-height ratio, waist-to-hip ratio (WHR), a body shape index, abdominal volume index, body adiposity index, body roundness index, conicity index, triglyceride-glucose index, visceral adiposity index, Chinese visceral adiposity index (CVAI), lipid accumulation product, estimated glucose disposal rate (eGDR), triglyceride-to-HDL ratio, and cardiometabolic index. Binary logistic regression, restricted cubic spline (RCS), and receiver operating characteristic curves were used to examine the associations of these indices with SCA.

Results: In multivariable logistic regression analyses, after adjusting for potential confounders, per 1.0-standard deviation (SD) increase in CVAI (OR, 95% CI: 1.68, 1.16-2.47), eGDR_WHR (eGDR calculated with WHR; OR, 95% CI: 0.44, 0.22-0.82), and eGDR_WC (eGDR calculated with waist circumference; OR, 95% CI: 0.49, 0.24-0.93) were significantly associated with SCA. CVAI exhibited the highest area under the curve (AUC) in diagnosing SCA, with a value of 0.73 (95% CI: 0.69-0.77). RCS analyses indicated a linear and positive association between CVAI and SCA in the overall population and the females. Subgroup analyses and sensitivity analyses further supported the association between CVAI and SCA. Additionally, adding CVAI to the Steno Type 1 Risk Engine (ST1RE) improved the reclassification, but did not enhance the overall discriminative ability of ST1RE to identify SCA.

Conclusion: Among various OIRIs, CVAI shows the strongest association with SCA in adults with T1D. These findings suggest that CVAI may merit further longitudinal investigation as a potential marker for SCA assessment in this population.

Keywords: Chinese visceral adiposity index; Insulin resistance; Obesity; Subclinical atherosclerosis; Type 1 diabetes.

Fig. 1

The flowchart of study participants

Fig. 2

ROC curves of the top six OIRIs (CVAI, WHtR, BRI, AVI, CI, eGDR_WHR) for diagnosing SCA in T1D participants. The ROC curves of WHtR and BRI completely overlap. The solid dot represents the optimal cutoff, while the gray dashed line represents the highest J value. Abbreviations: AVI, abdominal volume index; BRI, body roundness index; CI, conicity index; CVAI, Chinese visceral adiposity index; eGDR_WHR, estimated glucose disposal rate calculated with WHR; OIRIs, obesity- and insulin resistance-related indices; ROC, receiver operating characteristic; SCA, subclinical carotid atherosclerosis; T1D, type 1 diabetes; WHtR, waist-to-height ratio

Fig. 3

Association between CVAI and SCA in different T1D participant subgroups. Each subgroup was adjusted for age, sex, diabetes duration, smoking, alcohol drinking, family history of any diabetes, hypertension, HDL, LDL, FPG, and ACEI. Odds ratios for SCA are presented as per 1.0-SD increase in CVAI. Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; CVAI, Chinese visceral adiposity index; FPG, fasting plasma glucose; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; SCA, subclinical carotid atherosclerosis; T1D, type 1 diabetes

Fig. 4

Restricted cubic spline curves for association of CVAI with SCA in T1D participants. A Association in the overall population; B Association in males; C Association in females. Odds ratios are indicated by solid lines and 95% CIs by shaded areas. In A, RCS model adjusted for age, sex, diabetes duration, smoking, alcohol drinking, family history of any diabetes, hypertension, HDL, LDL, FPG, and ACEI. In B and C, RCS model adjusted for age, diabetes duration, smoking, alcohol drinking, family history of any diabetes, hypertension, HDL, LDL, FPG, and ACEI. Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; CVAI, Chinese visceral adiposity index; FPG, fasting plasma glucose; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; RCS, restricted cubic spline; SCA, subclinical carotid atherosclerosis; T1D, type 1 diabetes

Fig. 5

Receiver operating characteristic curve of CVAI to predict SCA in T1D participants. The ST1RE incorporated age, female, smoking, diabetes duration, SBP, LDL, HbA1c, eGFR, and albuminuria. The solid dot represents the optimal cutoff, while the gray dashed line represents the highest J value. Abbreviations: CVAI, Chinese visceral adiposity index; eGFR, estimated glomerular filtration rate; HbA1c, hemoglobin A1c; LDL, low density lipoprotein cholesterol; SBP, systolic blood pressure; SCA, subclinical carotid atherosclerosis; ST1RE, Steno Type 1 Risk Engine; T1D, type 1 diabetes