Independent of body mass index, waist circumference and lipid levels, elevated visceral fat index significantly increases the risk of kidney disease in people with type 2 diabetes

Chronic kidney disease (CKD) is one of the most common microvascular complications in patients with type 2 diabetes. The risk of death in people with diabetic nephropathy is more than 80 times higher than that of the general population. Therefore, the prevention, identification, diagnosis and treatment of diabetic nephropathy has always been one of the focuses and hot topics of current medical research.

Visceral fat is a type of human fat. Unlike subcutaneous fat (the "fat" that we usually know as the body's touchable fat), visceral fat is distributed around our internal organs. A small amount of visceral fat is used to protect the organs, but once it increases in large quantities, it will cause a series of health problems such as cardiovascular and cerebrovascular events, diabetes, and fatty liver. However, there is currently no prospective study to evaluate the association between visceral fat levels and CKD in people with type 2 diabetes. In view of this, Zhou Chun, a graduate student at the National Clinical Research Center for Kidney Diseases of Southern Hospital, and others published a research paper in the biomedical journal Diabetes/Metabolism Research & Reviews , finding that an increase in the visceral fat index in people with type 2 diabetes significantly increases their subsequent risk of CKD. Professor Nie Jing and Professor Qin Xianhui of Southern Hospital are the corresponding authors.

This study included 10,132 participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, with an average age of about 63 years and 38.6% women. Because traditional anthropometric methods such as body mass index (BMI) and waist circumference (WC) cannot distinguish visceral adipose tissue from subcutaneous adipose tissue, and the use of computed tomography (CT) and magnetic resonance imaging (MRI) to measure visceral fat is usually inconvenient, expensive, and has radiation risks, the visceral fat index (VAI) formula was used to estimate visceral fat content in this study. Gender-specific VAI was calculated from BMI, WC, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C).

After 26,168 person-years of follow-up, approximately 60% of the participants had renal outcomes. Overall, independent of a series of traditional risk factors and various components of VAI, including BMI, WC, TG, and HDL-C, VAI was continuously positively correlated with the risk of subsequent kidney disease in people with type 2 diabetes (Figure 1). When VAI was divided into quartiles, the risk of CKD in people with higher VAI (highest quartile) was significantly increased by 27% compared with people with lower VAI (first quartile).

Figure 1. The mean visceral index (VAI) in the diabetic population is continuously positively correlated with the subsequent risk of kidney disease.

Our results showed that visceral fat was significantly positively correlated with the risk of adverse CKD outcomes in people with type 2 diabetes . VAI calculated based on traditional indicators is independent of its components and may be used as a simple and useful tool to identify kidney damage in people with type 2 diabetes. VAI combined with a comprehensive assessment of other known risk factors may further improve the risk stratification and prediction of CKD in people with diabetes. Making full use of the simplest known clinical indicators and further exploring their potential clinical value has important clinical and public health value for population health status assessment and risk identification.

References:

Zhou C, Zhang Y, Yang S, He P, Wu Q, Ye Z, Liu M, Zhang Y, Li R, Liu C, Jiang J, Hou FF, Nie J, Qin X. Associations between visceral adiposity index and incident nephropathy outcomes in diabetic patients: Insights from the ACCORD trial. Diabetes Metab Res Rev . 2022; e3602.

Editor: Zhou Chunxianghao

Reviewer: Qin Xianhui

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