Background/Aims: Our aim was to evaluate whether visceral adiposity index (VAI) could predict the risk of type 2 diabetes (T2D) in different genders and to compare the predictive ability between VAI and other fatness indices. Methods: Four thousand seventy-eight participants including 1,817 men and 2,261 women, aged 18 and older and free of T2D at baseline were enrolled in 2010 and followed up for 4 years. New cases of T2D were identified via the annual medical examination. Cox regression analysis was used to assess the association between VAI and incidence of T2D. Receiver operating characteristic curve and area under the curves (AUC) were applied to compare the prediction ability of T2D between VAI and other fatness indices. Results: During the 4-year follow-up, 153 (8.42%) of 1,817 men and 88 (3.89%) of 2,261 women developed T2D. The multivariable-adjusted hazards ratios for developing T2D in the highest tertile of VAI scores were 2.854 (95% CI 1.815-4.487) in men and 3.551 (95% CI 1.586-7.955) in women. The AUC of VAI was not higher than that of other fatness indices. Conclusions: VAI could predict the risk of T2D among Chinese adults, especially in women. However, the prediction ability of T2D risk for VAI was not higher than that of the other fatness indices.

Roglic G, Unwin N: Mortality attributable to diabetes: estimates for the year 2010. Diabetes Res Clin Pract 2010;87:15-19.
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.
[A mass survey of diabetes mellitus in a population of 300,000 in 14 provinces and municipalities in China (author's transl)]. Zhonghua Nei Ke Za Zhi 1981;20:678-683.
Pan XR, Yang WY, Li GW, Liu J: Prevalence of diabetes and its risk factors in China, 1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care 1997;20:1664-1669.
Gu D, Reynolds K, Duan X, Xin X, Chen J, Wu X, Mo J, Whelton PK, He J; InterASIA Collaborative Group: Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: international Collaborative Study of Cardiovascular Disease in Asia (InterASIA). Diabetologia 2003;46:1190-1198.
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.
Neeland IJ, Turer AT, Ayers CR, Powell-Wiley TM, Vega GL, Farzaneh-Far R, Grundy SM, Khera A, McGuire DK, de Lemos JA: Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults. JAMA 2012;308:1150-1159.
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.
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.
Goodpaster BH, Krishnaswami S, Resnick H, Kelley DE, Haggerty C, Harris TB, Schwartz AV, Kritchevsky S, Newman AB: Association between regional adipose tissue distribution and both type 2 diabetes and impaired glucose tolerance in elderly men and women. Diabetes Care 2003;26:372-379.
Cornier MA, Després JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, Lopez-Jimenez F, Rao G, St-Onge MP, Towfighi A, Poirier P; American Heart Association Obesity Committee of the Council on Nutrition; Physical Activity and Metabolism; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Cardiovascular Disease in the Young; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing, Council on Epidemiology and Prevention; Council on the Kidney in Cardiovascular Disease, and Stroke Council: Assessing adiposity: a scientific statement from the American Heart Association. Circulation 2011;124:1996-2019.
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.
Oh JY, Sung YA, Lee HJ: The visceral adiposity index as a predictor of insulin resistance in young women with polycystic ovary syndrome. Obesity (Silver Spring) 2013;21:1690-1694.
Li Y, Zhou C, Shao X, Liu X, Guo J, Zhang Y, Wang H, Wang X, Li B, Deng K, Liu Q, Holthöfer H, Zou H: Waist phenotype and chronic kidney disease in a Chinese population aged 40 years and older. PLoS One 2014;9:e92322.
Du T, Sun X, Huo R, Yu X: Visceral adiposity index, hypertriglyceridemic waist and risk of diabetes: the China Health and Nutrition Survey 2009. Int J Obes (Lond) 2014;38:840-847.
Liu PJ, Ma F, Lou HP, Chen Y: Visceral adiposity index is associated with pre-diabetes and type 2 diabetes mellitus in Chinese adults aged 20-50. Ann Nutr Metab 2016;68:235-243.
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.
Wang Y, He S, He J, Wang S, Liu K, Chen X: Predictive value of visceral adiposity index for type 2 diabetes mellitus: a 15-year prospective cohort study. Herz 2015;40(suppl):277-281.
Kuk JL, Lee S, Heymsfield SB, Ross R: Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr 2005;81:1330-1334.
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.
Li R, Lu W, Jia J, Zhang S, Shi L, Li Y, Yang Q, Kan H: Relationships between indices of obesity and its cardiovascular comorbidities in a Chinese population. Circ J 2008;72:973-978.
Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group: The metabolic syndrome - a new worldwide definition. Lancet 2005;366:1059-1062.
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.
DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837-845.
Biggerstaff BJ: Comparing diagnostic tests: a simple graphic using likelihood ratios. Stat Med 2000;19:649-663.
Després JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, Rodés-Cabau J, Bertrand OF, Poirier P: Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol 2008;28:1039-1049.
Sargeant LA, Bennett FI, Forrester TE, Cooper RS, Wilks RJ: Predicting incident diabetes in Jamaica: the role of anthropometry. Obes Res 2002;10:792-798.
Stevens J, Couper D, Pankow J, Folsom AR, Duncan BB, Nieto FJ, Jones D, Tyroler HA: Sensitivity and specificity of anthropometrics for the prediction of diabetes in a biracial cohort. Obes Res 2001;9:696-705.
Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB: Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr 2005;81:555-563.
Folsom AR, Kushi LH, Anderson KE, Mink PJ, Olson JE, Hong CP, Sellers TA, Lazovich D, Prineas RJ: Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Arch Intern Med 2000;160:2117-2128.
Astrup A, Finer N: Redefining type 2 diabetes: ‘diabesity' or ‘obesity dependent diabetes mellitus'?. Obes Rev 2000;1:57-59.
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.
Hunter GR, Chandler-Laney PC, Brock DW, Lara-Castro C, Fernandez JR, Gower BA: Fat distribution, aerobic fitness, blood lipids, and insulin sensitivity in African-American and European-American women. Obesity (Silver Spring) 2010;18:274-281.
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.
Després JP: Intra-abdominal obesity: an untreated risk factor for type 2 diabetes and cardiovascular disease. J Endocrinol Invest 2006;29(3 suppl 1):77-82.
Fontana L, Eagon JC, Trujillo ME, Scherer PE, Klein S: Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes 2007;56:1010-1013.
Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Charalampidis P, Livadas S, Kollias A, Sabico SL, Chrousos GP: Visceral adiposity index is highly associated with adiponectin values and glycaemic disturbances. Eur J Clin Invest 2013;43:183-189.
Blaak E: Sex differences in the control of glucose homeostasis. Curr Opin Clin Nutr Metab Care 2008;11:500-504.
Meisinger C, Döring A, Thorand B, Heier M, Löwel H: Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg Cohort Study. Am J Clin Nutr 2006;84:483-489.
Schulze MB, Heidemann C, Schienkiewitz A, Bergmann MM, Hoffmann K, Boeing H: Comparison of anthropometric characteristics in predicting the incidence of type 2 diabetes in the EPIC-Potsdam Study. Diabetes Care 2006;29:1921-1923.
Tulloch-Reid MK, Williams DE, Looker HC, Hanson RL, Knowler WC: Do measures of body fat distribution provide information on the risk of type 2 diabetes in addition to measures of general obesity? Comparison of anthropometric predictors of type 2 diabetes in Pima Indians. Diabetes Care 2003;26:2556-2561.
Vazquez G, Duval S, Jacobs DR Jr, Silventoinen K: Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. Epidemiol Rev 2007;29:115-128.
Wannamethee SG, Papacosta O, Whincup PH, Carson C, Thomas MC, Lawlor DA, Ebrahim S, Sattar N: Assessing prediction of diabetes in older adults using different adiposity measures: a 7 year prospective study in 6,923 older men and women. Diabetologia 2010;53:890-898.
Bozorgmanesh M, Hadaegh F, Azizi F: Diabetes prediction, lipid accumulation product, and adiposity measures; 6-year follow-up: Tehran lipid and glucose study. Lipids Health Dis 2010;9:45.
Hardy DS, Stallings DT, Garvin JT, Gachupin FC, Xu H, Racette SB: Anthropometric discriminators of type 2 diabetes among White and Black American adults. J Diabetes 2016, Epub ahead of print.
Ferrannini E, Sironi AM, Iozzo P, Gastaldelli A: Intra-abdominal adiposity, abdominal obesity, and cardiometabolic risk. Eur Heart J 2008;suppl 10:B4-B10.
Jayawardana R, Ranasinghe P, Sheriff MH, Matthews DR, Katulanda P: Waist to height ratio: a better anthropometric marker of diabetes and cardio-metabolic risks in South Asian adults. Diabetes Res Clin Pract 2013;99:292-299.
Hadaegh F, Shafiee G, Azizi F: Anthropometric predictors of incident type 2 diabetes mellitus in Iranian women. Ann Saudi Med 2009;29:194-200.
Kahn HS, Valdez R: Metabolic risks identified by the combination of enlarged waist and elevated triacylglycerol concentration. Am J Clin Nutr 2003;78:928-934.
Unger RH: Lipid overload and overflow: metabolic trauma and the metabolic syndrome. Trends Endocrinol Metab 2003;14:398-403.
Unger RH: Minireview: weapons of lean body mass destruction: the role of ectopic lipids in the metabolic syndrome. Endocrinology 2003;144:5159-5165.
Ashwell M, Cole TJ, Dixon AK: Ratio of waist circumference to height is strong predictor of intra-abdominal fat. BMJ 1996;313:559-560.
Janghorbani M, Amini M: The visceral adiposity index in comparison with easily measurable anthropometric markers did not improve prediction of diabetes. Can J Diabetes 2016;pii:S1499-2671(15)30074-5.
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