Original Research
Visceral Adiposity Index as a Predictor of Chronic Kidney Disease in a Relatively Healthy Population in Taiwan

https://doi.org/10.1053/j.jrn.2017.07.006Get rights and content

Objectives

Abdominal obesity is an independent risk factor for cardiovascular disease and chronic kidney disease (CKD). Visceral adiposity index (VAI), a simple formula representing visceral adipose dysfunction, has already been proven to have a strong correlation with various cardiometabolic disorders. Limited studies are available regarding the relationship between VAI and renal function decline. Therefore, the purpose of this study was to evaluate the relationship between VAI and renal function and to estimate the risk of chronic kidney disease in a relatively healthy adult population in Taiwan.

Design

The design of the study is retrospective cross-sectional analysis.

Subjects

This study involved 23,570 subjects aged ≥18 years who underwent annual heath checkups between January and December 2013. A multivariate logistic regression model was used to assess the relationship between VAI and CKD. Receiver-operating characteristic curve and Youden index were developed to determine the discrimination power of VAI for metabolic syndrome and CKD.

Intervention

None, observational study.

Main outcome measure

The main outcome measure of this study was CKD.

Results

In our study, the adjusted odds ratio (OR) of abnormal VAI for CKD was 1.5 (95% confidence interval [CI], 1.08-2.08; P = .016) in all subjects. A higher VAI was superior in association with CKD in men than women (OR, 1.62; 95% CI, 1.13-2.32; P = .009 vs. OR, 1.28; 95% CI, 0.66-2.47; P = .469, respectively). The area under the curve for VAI was 0.694 (95% CI, 0.660-0.729; P < .001), and using a Youden index with a cut-off VAI value of 2.96 for CKD discrimination obtained a sensitivity of 67.7% and specificity of 65.1%.

Conclusions

A higher VAI score was associated with increased risks of CKD. VAI would be an applicable tool for early detection of CKD in relatively healthy adults in Taiwan, especially men.

Introduction

Many studies have demonstrated that there is a strong association between chronic kidney disease (CKD) and obesity. The prevalence of CKD increases with increasing body mass index (BMI) after adjusting for diabetes and hypertension. According to a United States Renal Data System report, Taiwan had the highest prevalence of treated end-stage renal disease in 2013.1 Early recognition and management of CKD are critical.

In light of the impact of obesity on chronic systemic disease, the distribution of adipose tissue is rather important. Abdominal obesity and dysfunctional visceral fat, resulting in insulin resistance and an increased hypertension and diabetes risk, are key components of cardiometabolic disease.2 As many studies have proven, compared with subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) is a more prominent contributor to cardiometabolic problems including metabolic syndrome (MetS), insulin resistance, dyslipidemia, and elevated liver enzyme.3, 4, 5 Furthermore, cytokines secreted by VAT may contribute to inflammatory status, glomerular sclerosis, and further renal function impairment.6

Waist circumference (WC) and waist-to-hip ratio (WHR) are the most commonly used methods to measure abdominal obesity. However, both WC and WHR have limited accuracy in distinguishing between VAT and SAT. However, computed tomography and magnetic resonance imaging are not recommended for the quantitative evaluation of VAT and SAT in routine practice because of radiation exposure and the expense. Therefore, an easily applicable marker to measure body fat distribution and adipose dysfunction would be important and helpful for clinicians in a practical community survey.

In 2009, Amato and his research group developed the visceral adiposity index (VAI), a mathematical method that used both anthropometric (BMI and WC) and functional (triglycerides [TGs] and high-density lipoprotein [HDL]) parameters, as a simple surrogate marker representing visceral adipose dysfunction in a Caucasian population.7 However, few studies have investigated the correlation between VAI and CKD. Research regarding the application of VAI to non-Caucasian populations and the relationship between VAI and CKD is still limited.

Therefore, the aim of this study was to apply the VAI to a Taiwanese adult population, to evaluate dysfunctional visceral adiposity, to identify the association of VAI with MetS and CKD.

Section snippets

Subjects

This retrospective cross-sectional study involved subjects aged ≥18 years who underwent annual health checkups between January and December 2013. Subjects with incomplete data; a history of chronic disease or a medication that might alter their metabolic state or kidney function test (e.g., thyroid or hypothalamic diseases, adrenal disease, renal cancer, glomerulonephritis, renal failure on renal replacement therapy, liver cirrhosis, or diuretics use); who were pregnant; who did not complete

Baseline Characteristics of Different VAI Quartiles

A total of 23,570 subjects were enrolled in this study. There were 13,077 men (55.48%) and 10,493 women (44.52%). All participants were divided into 4 groups based on their VAI quartile. The median VAI for each quartile was 1.194 (1.002, 1.355), 1.862 (1.680, 2.055), 2.834 (2.526, 3.211), and 5.319 (4.339, 7.217) from the first to fourth quartile group, respectively (for trend, P < .001). Median ages were 37 (33, 41), 38 (35, 43), 39 (35, 44), and 41 (37, 46) years from the first to fourth

Discussion

Our study demonstrated that VAI has an outstanding ability to discriminate not only MetS (AUC 0.924; 95% CI, 0.919-0.929; P < .001) with a cut-off value of 3.88 (sensitivity, 87.9%; specificity, 83.8%; positive likelihood ratio, 5.43; negative likelihood ratio, 0.15), but also CKD (AUC, 0.694; 95% CI, 0.660-0.729; P < .001) in Asian populations. Cardiometabolic factors such as FPG, BP, and lipid profile demonstrated a significant increasing trend among VAI quartiles. Significant decreasing

Acknowledgments

The involved subjects underwent annual health checkups at the Linkou (northern Taiwan) and Chiayi (southern Taiwan) branches of Chang Gung Memorial Hospital. The authors would like to thank all colleagues of the Family Medicine, Health and Management and Emergency Department in the Keelung, Taoyuan, Linkou, and Chiayi branches of Chang Gung Memorial Hospital who participated in data collection. This study had no funding source. Thanks also to Chang Gung Memorial Hospital research resources.

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      In term of the associations between VAI and CKD, previous studies have yielded inconsistent results. Several studies [12–15] but not all studies [16–18] has demonstrated a significant association between VAI and CKD. Moreover, it is not clear whether there are any gender-specific association between VAI and CKD.

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      As one of the applicable index representing visceral adiposity in clinical practice, VAI is associated with deterioration of renal function based on previous publications. By including 23,570 subjects aged 18 years or older, a recent cross-sectional study conducted by Chen and colleagues reporting the relationship between VAI and prevalence of CKD [27]. In the study, a higher VAI was associated with increased risk of prevalent CKD.

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    Conflict of interest: The authors declare that they have no relevant conflicts of interest to disclose.

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