Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico.
Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico.
Clin Nutr. 2020 May;39(5):1613-1621. doi: 10.1016/j.clnu.2019.07.012. Epub 2019 Jul 30.
BACKGROUND & AIMS: Intra-abdominal and visceral fat (VAT) are risk factors for the development of cardio-metabolic comorbidities; however its clinical assessment is limited by technology and required expertise for its assessment. We aimed to develop a novel score (METS-VF) to estimate VAT by combining the non-insulin-based METS-IR index, waist-height ratio (WHtr), age and sex.
We developed METS-VF in a sample of 366 individuals with Dual X-ray absorptiometry (DXA). METS-VF was modeled using non-linear regression and validated in two replication cohorts with DXA (n = 184, with n = 118 who also had MRI) and bio-electrical impedance (n = 991). We also assessed METS-VF to predict incident type 2 diabetes (T2D) and arterial hypertension independent of body-mass index (BMI) in our Metabolic Syndrome Cohort (n = 6144).
We defined METS-VF as: 4.466 + 0.011*(Ln(METS-IR)) + 3.239*(Ln(WHtr)) + 0.319*(Sex) + 0.594*(Ln(Age)). METS-VF showed better performance compared to other VAT surrogates using either DXA (AUC 0.896 95% CI 0.847-0.945) or MRI (AUC 0.842 95% CI 0.771-0.913) as gold standards. We identified a METS-VF cut-off point >7.18 in healthy patients which has 100% sensitivity (95% CI 76.8-100) and 87.2% specificity (95% CI 79.1-93.0) to identify increased VAT (>100 cm). METS-VF also had adequate performance in subjects with metabolically-healthy obesity. Finally, in our metabolic syndrome cohort, subjects in the upper quintiles of METS-VF (>7.2) had 3.8 and 2.0-fold higher risk of incident T2D and hypertension, respectively (p < 0.001). This effect was independent of BMI for both outcomes.
METS-VF is a novel surrogate to estimate VAT, which has better performance compared to other surrogate VAT indexes and is predictive of incident T2D and hypertension. METS-VF could be a useful tool to assess cardio-metabolic risk in primary care practice and research settings.
腹部和内脏脂肪（VAT）是发生心脏代谢合并症的危险因素；但由于技术限制以及评估所需的专业知识，其临床评估受到限制。我们旨在通过结合非胰岛素基础的 METS-IR 指数、腰围身高比（WHtr）、年龄和性别，开发一种新的评分（METS-VF）来估计 VAT。
我们使用双能 X 射线吸收法（DXA）对 366 名个体进行了 METS-VF 研究。使用非线性回归建立了 METS-VF 模型，并在具有 DXA 的两个复制队列（n=184，其中 n=118 人也进行了 MRI）和生物电阻抗（n=991）中进行了验证。我们还评估了 METS-VF 对我们的代谢综合征队列（n=6144）中 BMI 独立的 2 型糖尿病（T2D）和动脉高血压的预测作用。
我们将 METS-VF 定义为：4.466+0.011*(Ln(METS-IR))+3.239*(Ln(WHtr))+0.319*(Sex)+0.594*(Ln(Age))。与使用 DXA（AUC 0.896，95%CI 0.847-0.945）或 MRI（AUC 0.842，95%CI 0.771-0.913）作为金标准的其他 VAT 替代物相比，METS-VF 的性能更好。我们确定了一个健康患者的 METS-VF 截断值＞7.18，该值具有 100%的敏感性（95%CI 76.8-100）和 87.2%的特异性（95%CI 79.1-93.0），以识别增加的 VAT（＞100cm）。METS-VF 在代谢健康肥胖患者中也具有良好的性能。最后，在我们的代谢综合征队列中，METS-VF 上四分位数（＞7.2）的受试者发生 T2D 和高血压的风险分别增加 3.8 倍和 2.0 倍（p＜0.001）。这两种结果都独立于 BMI。
METS-VF 是一种估计 VAT 的新替代物，与其他替代 VAT 指数相比具有更好的性能，并且可以预测 T2D 和高血压的发生。METS-VF 可能是评估初级保健实践和研究环境中心血管代谢风险的有用工具。
