Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China.
Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing, 400042, China.
Obes Surg. 2021 Feb;31(2):805-812. doi: 10.1007/s11695-020-05034-w. Epub 2020 Oct 16.
Visceral Adiposity Index (VAI) is considered to be a reliable indicator for evaluation of visceral adipose dysfunction and cardiovascular disease risk. However, no previous studies have reported the VAI variation after bariatric surgery and the predictive effect of preoperative VAI on diabetes remission. The aim of this study is to evaluate whether preoperative VAI is useful to predict diabetes remission in low BMI Chinese patients after bariatric surgery.
Eighty-seven type 2 diabetes mellitus patients with BMI < 35 kg/m underwent bariatric surgery from May 2010 to March 2018 in our hospital. VAI, glycolipid metabolic parameters, and anthropometric variables were measured before and 4 years after surgery. Complete remission was defined as follows: HbA1c < 6%, FPG < 5.6 mmol/L, achieved without anti-diabetic medication. Analysis included using binary logistic regression to identify predictors and ROC curves to determine clinically useful cutoff values.
Seventy-four patients (85.1%) underwent Roux-en-Y gastric bypass (RYGB), while the remaining 13 patients (14.9%) underwent sleeve gastrectomy (SG). Patients' weight, glycemic control, and lipid profiles were improved significantly after surgery (p < 0.05). Complete remission of T2DM was found in 35 patients (40.2%) 1 year after surgery. VAI decreased from baseline 4.41 to 1.74 in 3 months after surgery (p < 0.05) and showed a downward trend over the period from 6 months to 4 years. Patients with complete remission had a significantly shorter duration of diabetes, lower HbA1c level, and higher VAI, in comparison to those without remission. Binary logistics regression and ROC curves analysis confirm that VAI, HbA1c, and duration of diabetes can predict diabetes remission after bariatric surgery, and the VAI of 4.46 is a useful threshold for predicting surgical efficacy.
VAI is a significant predictor of diabetes remission for lower BMI patients with T2DM following bariatric surgery in China. The VAI of 4.46 is a useful threshold for predicting surgical efficacy. Multi-center and larger prospective studies are needed to confirm our findings.
内脏脂肪指数（VAI）被认为是评估内脏脂肪功能障碍和心血管疾病风险的可靠指标。然而，以前的研究没有报告过减重手术后 VAI 的变化，以及术前 VAI 对糖尿病缓解的预测作用。本研究旨在评估术前 VAI 是否有助于预测中国低 BMI 患者减重手术后的糖尿病缓解情况。
2010 年 5 月至 2018 年 3 月，我院收治了 87 例 BMI<35kg/m2 的 2 型糖尿病患者行减重手术。手术前后测量 VAI、糖脂代谢参数和人体测量学变量。完全缓解定义为：HbA1c<6%，FPG<5.6mmol/L，无需服用降糖药物。分析包括使用二项逻辑回归来识别预测因子和 ROC 曲线来确定临床有用的截断值。
74 例（85.1%）患者行 Roux-en-Y 胃旁路术（RYGB），其余 13 例（14.9%）患者行袖状胃切除术（SG）。术后患者体重、血糖控制和血脂谱均显著改善（p<0.05）。术后 1 年，35 例（40.2%）患者达到 T2DM 完全缓解。术后 3 个月 VAI 从基线的 4.41 降至 1.74（p<0.05），6 个月至 4 年期间呈下降趋势。与未缓解者相比，完全缓解者糖尿病病程较短，HbA1c 水平较低，VAI 较高。二项逻辑回归和 ROC 曲线分析证实，VAI、HbA1c 和糖尿病病程可以预测减重手术后的糖尿病缓解，VAI 为 4.46 是预测手术疗效的有用阈值。
VAI 是中国低 BMI 2 型糖尿病患者减重手术后糖尿病缓解的重要预测因子。VAI 为 4.46 是预测手术疗效的有用阈值。需要多中心和更大规模的前瞻性研究来证实我们的发现。
