Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus-a multicenter study in China.

Publisher: BioMed Central Country of Publication: England NLM ID: 101147637 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-2840 (Electronic) Linking ISSN: 14752840 NLM ISO Abbreviation: Cardiovasc Diabetol Subsets: MEDLINE

Original Publication: London : BioMed Central, [2002-

Cardiovascular Diseases* ; Diabetes Mellitus, Type 2* ; Atherosclerosis*; Humans ; Obesity, Abdominal ; Overweight ; Obesity ; China ; Cholesterol, HDL

Background: Visceral obesity is associated with high cardiovascular events risk in type 2 diabetes mellitus (T2DM). Whether normal-weight visceral obesity will pose a higher atherosclerotic cardiovascular disease (ASCVD) risk than body mass index (BMI)-defined overweight or obese counterparts with or without visceral obesity remains unclear. We aimed to explore the relationship between general obesity and visceral obesity and 10-year ASCVD risk in patients with T2DM.
Methods: Patients with T2DM (6997) who satisfied the requirements for inclusion were enrolled. Patients were considered to have normal weight when 18.5 kg/m ²  ≤ BMI < 24 kg/m ² ; overweight when 24 kg/m ²  ≤ BMI < 28 kg/m ² ; and obesity when BMI ≥ 28 kg/m ² . Visceral obesity was defined as a visceral fat area (VFA) ≥ 100 cm ² . Patients were separated into six groups based on BMI and VFA. The odd ratios (OR) for a high 10-year ASCVD risk for different combinations of BMI and VFA were analysed using stepwise logistic regression. Receiver operating characteristic (ROC) curves for diagnosing the high 10-year ASCVD risk were constructed, and areas under the ROC curves were estimated. Potential non-linear relationships between VFA levels and high 10-year ASCVD risk were examined using restricted cubic splines (knot = 4). Multilinear regression was used to identify factors affecting VFA in patients with T2DM.
Results: In patients with T2DM, subjects with normal-weight visceral obesity had the highest 10-year ASCVD risk among the six groups, which had more than a 2-fold or 3-fold higher OR than those who were overweight or obese according to BMI but did not have visceral obesity (all P < 0.05). The VFA threshold for high 10-year ASCVD risk was 90 cm ² . Multilinear regression showed significant differences in the effect of age, hypertension, drinking, fasting serum insulin, fasting plasma glucose, 2 h postprandial C-peptide, triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol on VFA in patients with T2DM (all P < 0.05).
Conclusions: T2DM patients with normal-weight visceral obesity had a higher 10-year ASCVD risk than BMI-defined overweight or obese counterparts with or without visceral obesity, which should initiate standardised management for ASCVD primary prevention.
(© 2023. The Author(s).)

Crit Rev Food Sci Nutr. 2022;62(29):8078-8098. (PMID: 33998940)
Arterioscler Thromb Vasc Biol. 2007 May;27(5):996-1003. (PMID: 17303782)
Cardiovasc Diabetol. 2019 Oct 22;18(1):137. (PMID: 31640702)
Diabetes Care. 2004 Feb;27(2):372-7. (PMID: 14747216)
Zhonghua Liu Xing Bing Xue Za Zhi. 2022 May 10;43(5):609-626. (PMID: 35589563)
J Clin Lipidol. 2015 Sep-Oct;9(5):640-6.e2. (PMID: 26350809)
Nutrition. 2022 Jan;93:111443. (PMID: 34563934)
Life Sci. 2019 Mar 1;220:69-75. (PMID: 30685450)
Front Cardiovasc Med. 2017 Feb 02;4:3. (PMID: 28210619)
PLoS Med. 2022 Jun 13;19(6):e1004026. (PMID: 35696440)
J Geriatr Cardiol. 2019 Mar;16(3):182-241. (PMID: 31080465)
Endocr Rev. 2018 Apr 1;39(2):79-132. (PMID: 29518206)
Clin Interv Aging. 2019 Jun 20;14:1119-1129. (PMID: 31354254)
Circulation. 2018 Mar 27;137(13):1391-1406. (PMID: 29581366)
Arterioscler Thromb Vasc Biol. 2004 May;24(5):923-9. (PMID: 15016639)
Nutr Diabetes. 2016 Jul 18;6(7):e221. (PMID: 27428873)
Horm Metab Res. 2002 Nov-Dec;34(11-12):616-21. (PMID: 12660870)
Atherosclerosis. 2015 Sep;242(1):367-75. (PMID: 26255683)
Metabolism. 2019 Mar;92:71-81. (PMID: 30447223)
Biomed Environ Sci. 2017 Apr;30(4):244-254. (PMID: 28494834)
Diabetes Metab Syndr Obes. 2020 Nov 17;13:4413-4422. (PMID: 33235479)
Eat Weight Disord. 2021 May;26(4):1057-1068. (PMID: 32954485)
Obes Res Clin Pract. 2017 Sep - Oct;11(5 Suppl 1):133-143. (PMID: 28073639)
Zhonghua Xin Xue Guan Bing Za Zhi. 2016 Oct 24;44(10):833-853. (PMID: 27903370)
J Am Coll Cardiol. 2013 Feb 5;61(5):553-60. (PMID: 23369419)
Circulation. 2014 Jun 24;129(25 Suppl 2):S49-73. (PMID: 24222018)
Am J Clin Nutr. 2021 Feb 2;113(2):401-409. (PMID: 33381801)
Obes Res. 2005 Nov;13(11):1849-63. (PMID: 16339115)
Clin Chim Acta. 2020 Apr;503:128-135. (PMID: 31981585)
J Am Coll Cardiol. 2002 Feb 20;39(4):578-84. (PMID: 11849854)
Eur J Intern Med. 2018 Feb;48:6-17. (PMID: 29100895)
BMC Med. 2018 Dec 13;16(1):232. (PMID: 30541568)
Diabetes Care. 2022 Jan 1;45(Suppl 1):S17-S38. (PMID: 34964875)
Nat Rev Cardiol. 2019 Feb;16(2):83-99. (PMID: 30287946)
Circ Res. 2020 May 22;126(11):1477-1500. (PMID: 32437302)
Front Cardiovasc Med. 2022 Oct 11;9:978682. (PMID: 36304549)
Cardiovasc Diabetol. 2022 Nov 01;21(1):225. (PMID: 36320060)
BMC Med. 2020 Aug 21;18(1):224. (PMID: 32819363)
J Diabetes Complications. 2016 Mar;30(2):343-9. (PMID: 26620129)
Prog Cardiovasc Dis. 2018 Jul - Aug;61(2):142-150. (PMID: 29981771)
Diabetes Care. 2000 Apr;23(4):465-71. (PMID: 10857936)
Nat Rev Cardiol. 2021 Oct;18(10):689-700. (PMID: 33833450)
Nutrients. 2022 May 31;14(11):. (PMID: 35684121)
Circulation. 2006 Nov 21;114(21):2217-25. (PMID: 17088464)
Diabetes Care. 2005 Feb;28(2):451-3. (PMID: 15677816)
J Clin Endocrinol Metab. 2017 Nov 1;102(11):4173-4183. (PMID: 28938406)

Keywords: Atherosclerotic cardiovascular disease risk; Multicentre study; Normal weight; Obesity paradox; Type 2 diabetes mellitus; Visceral obesity

0 (Cholesterol, HDL)

Date Created: 20230612 Date Completed: 20230614 Latest Revision: 20230624

20240628

PMC10262529

10.1186/s12933-023-01876-7

37308932