Background/Aims: Diabetes mellitus and pre-diabetes are closely associated with visceral obesity. Visceral adiposity index (VAI) is a novel sex-specific index, indirectly expressing visceral adipose function. Our aim was to determine the associations of VAI with dysglycemia (the combination of diabetes and pre-diabetes) and to compare the predictive ability for dysglycemia between VAI and traditional obesity indices. Methods: We performed a cross-sectional analysis of the data of 2,754 Chinese community-dwelling people who participated in the health checkup. Sex-specific VAI tertile cut-off points were used as follows: 1.70, 2.77 in males and 0.98, 1.75 in females. Binary logistic regression models were performed to estimate the association of the higher values of all the obesity indices with pre-diabetes and diabetes. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was applied to compare the predictive potential for dysglycemia among the obesity indices. Results: VAI was the only index significantly associated with both pre-diabetes and diabetes in both sexes after adjusting for potential confounders. The results of ROC analysis and AUC showed that VAI possessed the largest AUC, followed by other obesity indices. Conclusions: Higher VAI values are positively associated with the presence of pre-diabetes and diabetes in Chinese adults.

Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J; China National Diabetes and Metabolic Disorders Study Group: Prevalence of diabetes among men and women in China. N Engl J Med 2010;362:1090-1101.
Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M: Prediabetes: a high-risk state for diabetes development. Lancet 2012;379:2279-2290.
Morris DH, Khunti K, Achana F, Srinivasan B, Gray LJ, Davies MJ, Webb D: Progression rates from HbA1c 6.0-6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Diabetologia 2013;56:1489-1493.
Pascot A, Lemieux S, Lemieux I, Prud'homme D, Tremblay A, Bouchard C, Nadeau A, Couillard C, Tchernof A, Bergeron J, Després JP: Age-related increase in visceral adipose tissue and body fat and the metabolic risk profile of premenopausal women. Diabetes Care 1999;22:1471-1478.
Brüünsgaard H, Pedersen BK: Age-related inflammatory cytokines and disease. Immunol Allergy Clin North Am 2003;23:15-39.
Matsuda M, Shimomura I: Increased oxidative stress in obesity: implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Obes Res Clin Pract 2013;7:e330-e341.
DeNino WF, Tchernof A, Dionne IJ, Toth MJ, Ades PA, Sites CK, Poehlman ET: Contribution of abdominal adiposity to age-related differences in insulin sensitivity and plasma lipids in healthy nonobese women. Diabetes Care 2001;24:925-932.
Rader DJ: Effect of insulin resistance, dyslipidemia, and intra-abdominal adiposity on the development of cardiovascular disease and diabetes mellitus. Am J Med 2007;120(3 suppl 1):S12-S18.
Iannucci CV, Capoccia D, Calabria M, Leonetti F: Metabolic syndrome and adipose tissue: new clinical aspects and therapeutic targets. Curr Pharm Des 2007;13:2148-2168.
Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, Vasan RS, Murabito JM, Meigs JB, Cupples LA, D'Agostino RB Sr, O'Donnell CJ: Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham heart study. Circulation 2007;116:39-48.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults - the evidence report. National Institutes of Health. Obes Res 1998;6(suppl 2):51S-209S.
Haslam DW, James WP: Obesity. Lancet 2005;366:1197-1209.
Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A; AlkaMeSy Study Group: Visceral adiposity index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 2010;33:920-922.
Elisha B, Messier V, Karelis A, Coderre L, Bernard S, Prud'homme D, Rabasa-Lhoret R: The visceral adiposity index: relationship with cardiometabolic risk factors in obese and overweight postmenopausal women - a MONET group study. Appl Physiol Nutr Metab 2013;38:892-899.
Mazzuca E, Battaglia S, Marrone O, Marotta AM, Castrogiovanni A, Esquinas C, Barcelò A, Barbé F, Bonsignore MR: Gender-specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea. J sleep Res 2014;23:13-21.
Yang F, Wang G, Wang Z, Sun M, Cao M, Zhu Z, Fu Q, Mao J, Shi Y, Yang T: Visceral adiposity index may be a surrogate marker for the assessment of the effects of obesity on arterial stiffness. PLoS One 2014;9:e104365.
Ding Y, Gu D, Zhang Y, Han W, Liu H, Qu Q: Significantly increased visceral adiposity index in prehypertension. PLoS One 2015;10:e0123414.
Bozorgmanesh M, Hadaegh F, Azizi F: Predictive performance of the visceral adiposity index for a visceral adiposity-related risk: type 2 diabetes. Lipids Health Dis 2011;10:88.
Chen C, Xu Y, Guo ZR, Yang J, Wu M, Hu XS: The application of visceral adiposity index in identifying type 2 diabetes risks based on a prospective cohort in China. Lipids Health Dis 2014;13:108.
Chen HY, Chiu YL, Chuang YF, Hsu SP, Pai MF, Yang JY, Peng YS: Visceral adiposity index and risks of cardiovascular events and mortality in prevalent hemodialysis patients. Cardiovasc Diabetol 2014;13:136.
Donahue RP, Stranges S, Rejman K, Rafalson LB, Dmochowski J, Trevisan M: Elevated cystatin C concentration and progression to pre-diabetes: the Western New York study. Diabetes Care 2007;30:1724-1729.
Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, Kitzmiller J, Knowler WC, Lebovitz H, Lernmark A, Nathan D, Palmer J, Rizza R, Saudek C, Shaw J, Steffes M, Stern M, Tuomilehto J, Zimmet P; Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003;26:3160-3167.
Zhou B; Coorperative Meta-Analysis Group of China Obesity Task Force: [Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population]. Zhonghua Liu Xing Bing Xue Za Zhi 2002;23:5-10.
World Health Organization: Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complication. WHO/NCD/NCS, 1999, pp 31-32.
Browning LM, Hsieh SD, Ashwell M: A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0 5 could be a suitable global boundary value. Nutr Res Rev 2010;23:247-269.
Xu Y, Wang L, He J, Bi Y, Li M, Wang T, Wang L, Jiang Y, Dai M, Lu J, Xu M, Li Y, Hu N, Li J, Mi S, Chen CS, Li G, Mu Y, Zhao J, Kong L, Chen J, Lai S, Wang W, Zhao W, Ning G; 2010 China Noncommunicable Disease Surveillance Group: Prevalence and control of diabetes in Chinese adults. JAMA 2013;310:948-959.
Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, van der Schouw YT, Spencer E, Moons KG, Tjønneland A, Halkjaer J, Jensen MK, Stegger J, Clavel-Chapelon F, Boutron-Ruault MC, Chajes V, Linseisen J, Kaaks R, Trichopoulou A, Trichopoulos D, Bamia C, Sieri S, Palli D, Tumino R, Vineis P, Panico S, Peeters PH, May AM, Bueno-de-Mesquita HB, van Duijnhoven FJ, Hallmans G, Weinehall L, Manjer J, Hedblad B, Lund E, Agudo A, Arriola L, Barricarte A, Navarro C, Martinez C, Quirós JR, Key T, Bingham S, Khaw KT, Boffetta P, Jenab M, Ferrari P, Riboli E: General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008;359:2105-2120.
Prospective Studies Collaboration, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, Qizilbash N, Collins R, Peto R: Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;373:1083-1096.
Lavie CJ, De Schutter A, Patel D, Artham SM, Milani RV: Body composition and coronary heart disease mortality - an obesity or a lean paradox? Mayo Clin Proc 2011;86:857-864.
Thibault R, Pichard C: The evaluation of body composition: a useful tool for clinical practice. Ann Nutr Metab 2012;60:6-16.
Koning L, Merchant AT, Pogue J, Anand SS: Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007;28:850-856.
Ashwell M, Gunn P, Gibson S: Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 2012;13:275-286.
Folsom AR, Kaye SA, Sellers TA, Hong CP, Cerhan JR, Potter JD, Prineas RJ: Body fat distribution and 5-year risk of death in older women. JAMA 1993;269:483-487.
Price GM, Uauy R, Breeze E, Bulpitt CJ, Fletcher AE: Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 2006;84:449-460.
Paula HA, Ribeiro Rde C, Rosado LE, Abranches MV, Franceschini Sdo C: Classic anthropometric and body composition indicators can predict risk of metabolic syndrome in elderly. Ann Nutr Metab 2012;60:264-271.
Esmaillzadeh A, Mirmiran P, Azizi F: Comparative evaluation of anthropometric measures to predict cardiovascular risk factors in Tehranian adult women. Public Health Nutr 2006;9:61-69.
Boden G, Shulman GI: Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and beta-cell dysfunction. Eur J Clin Invest 2002;32(suppl 3):14-23.
Russo GT, Labate AM, Giandalia A, Romeo EL, Villari P, Alibrandi A, Perdichizzi G, Cucinotta D: Twelve-month treatment with Liraglutide ameliorates visceral adiposity index and common cardiovascular risk factors in type 2 diabetes outpatients. J Endocrinol Invest 2015;38:81-89.
Amato MC, Giordano C, Pitrone M, Galluzzo A: Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population. Lipids Health Dis 2011;10:183.
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