Original ResearchVisceral Adiposity Index as a Predictor of Chronic Kidney Disease in a Relatively Healthy Population in Taiwan
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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Cited by (24)
Association between visceral adiposity index and chronic kidney disease: Evidence from the China Health and Retirement Longitudinal Study
2022, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :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.
Visceral adiposity index is associated with increased urinary albumin excretion: A population-based study
2019, Clinical NutritionCitation Excerpt :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.
Diagnostic value of visceral adiposity index in chronic kidney disease: a meta-analysis
2023, Acta Diabetologica
Conflict of interest: The authors declare that they have no relevant conflicts of interest to disclose.