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. 2025 Jun 14;24(1):256.
doi: 10.1186/s12933-025-02789-3.

Beyond overweight, visceral adiposity is associated with estimation of cardiovascular risk in patients living with type 1 diabetes: findings from the SFDT1 cohort

Laurence Salle  1   2 , Jean-Baptiste Julla  3   4 , Guy Fagherazzi  5 , Pierre Gourdy  6   7 , Erika Bezerra Parente  8   9   10   11 , Hélène Hanaire  6   12 , Sopio Tatulashvili  13 , Emmanuel Disse  14   15   16 , Sylvia Franc  17 , Samy Hadjadj  18 , Etienne Larger  19   20 , Caroline Sanz  21 , Patricia Vaduva  22 , René Valero  23   24 , Amélie Bonnefond  25   26   27 , Emmanuel Cosson  13   28 , Gloria A Aguayo  5 , Jean-Pierre Riveline  3   4 ; SFDT1 group
Affiliations

Beyond overweight, visceral adiposity is associated with estimation of cardiovascular risk in patients living with type 1 diabetes: findings from the SFDT1 cohort

Laurence Salle et al. Cardiovasc Diabetol. .

Abstract

Introduction & objectives: As in the general population, people living with type 1 diabetes (PWT1D) are faced with overweight and obesity, which contribute to cardiovascular (CV) risk. However, the role of visceral adiposity, due to its adverse metabolic profile, should also be addressed in PWT1D. We aimed to assess the 10-year CV risk of PWT1D according to body mass index (BMI) and waist-to-height ratio (WHtR), a parameter for estimating visceral adiposity.

Methods: In this cross-sectional study, PWT1D in primary CV prevention from the SFDT1 cohort were categorized by BMI status, either normal (18.5-24.9 kg/m2) or overweight/obesity (≥ 25 kg/m2), and by WHtR according to the validated threshold of 0.5. The 10-year CV risk was estimated using the Steno Type 1 Risk Engine and classified into three categories: low (< 10%), intermediate (10-20%) and high (> 20%). The distribution of CV risk was assessed using density plots. In multivariable analysis, the association between BMI, WHtR, and high estimated 10-year CV risk was studied using spline regression models with sex stratification. Thresholds were determined by the Receiver Operating Characteristic (ROC) curve.

Results: The study included 1,482 patients; 49.9% had a normal BMI, and 50.1% a BMI ≥ 25 kg/m2. The proportion of patients with high CV risk was higher in PWT1D with overweight/obesity (12% vs. 7%) and in those with WHtR ≥ 0.5 (13% vs. 4%). BMI was significantly associated with high CV risk in men (p = 0.001) but a non-significant trend was found in women (p = 0.053). WHtR was significantly associated with high CV risk in both men (p < 0.001) and women (p = 0.046). The BMI threshold associated with high CV risk was 24.9 kg/m2 for men, and the WHtR threshold was 0.5 for both men and women.

Conclusion: In PWT1D in condition of primary CV prevention, visceral adiposity, assessed by WHtR, is a more robust marker of estimated 10-year CV risk than overweight/obesity status in both men and women.

Keywords: Adiposity distribution; Body mass index; Cardiovascular risk; Registry; Sex; Type 1 diabetes; Waist circumference.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: SFDT1 was approved by an ethical committee on 5 November 2019 and is declared in clinical trial NCT04657783. Consent for publication: Not applicable. Competing interests: EBP reports receiving lecture honorariums from Astra Zeneca and Sanofi, and has been an employee of Boehringer Ingelheim since February 2024. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of the cardiovascular risk in the SFDT1 cohort by gender, body mass index class and waist/height ratio. A: whole cohort, B: distribution by gender, C: distribution by BMI categories, D: distribution by waist/height ratio. The percentage of the population in each of the score categories is shown on the graphs. The differences between the groups by gender (B), BMI (C) and waist/height ratio (D) are significant (p value < 0.001, Chi-squared test)
Fig. 2
Fig. 2
Association between high cardiovascular risk and body mass index. A: whole population (n = 1482, EDF = 6.4; Chi squared = 19.6; p-value = 0.010), B: men (n = 762, EDF = 2.3; Chi squared = 16.9; p-value = 0.001); C: women (n = 720, EDF = 8.6; Chi squared = 16.7; p-value = 0.053); BMI: body mass index. The model was adjusted by diabetes treatment, insulin dose and EPICES score. Blue line represents the median BMI
Fig. 3
Fig. 3
Association between high cardiovascular risk and Waist/height ratio. A: whole population (n = 1482, EDF = 2.2; Chi squared = 37.3; p-value < 0.001); B: men (n = 762, EDF = 2.6; Chi squared = 39.1; p-value < 0.001); C: women (n = 720, EDF = 1.0; Chi squared = 4.0; p-value = 0.046); WHtR: Waist/Height ratio. The model was adjusted for diabetes treatment, insulin dose and EPICES score. The blue line represents the median WHtR ratio
Fig. 4
Fig. 4
Association between high cardiovascular risk and Waist/height ratio according to body mass index class. A: normal weight men (n = 386, EDF = 2.2; Chi squared = 13.3; p-value < 0.001), B: overweight men (n = 376, 4.9, EDF = 16.9; Chi squared = 13.3; p-value = 0.001), C: normal weight women (n = 354, EDF = 1.0; Chi squared = 2.9, p-value = 0.086), D: overweight women (n = 366, EDF = 1.0; Chi squared = 1.7; p-value = 0.195). WHtR: Waist/Height ratio. The model was adjusted for diabetes treatment, insulin dose and social deprivation. The blue line represents the median WHtR ratio
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