Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Diabetes. 2024 Jan;16(1):e13463. doi: 10.1111/1753-0407.13463. Epub 2023 Sep 8.
"Obesity paradox" occurs in type 2 diabetes mellitus (T2DM) patients when body mass index (BMI) is applied to define obesity. We examined the association of visceral fat area (VFA) as an obesity measurement with arterial stiffness in seven ideal cardiovascular health metrics (ICVHMs).
A total of 29 048 patients were included in the analysis from June 2017 to April 2021 in 10 sites of National Metabolic Management Centers. ICVHMs were modified from the recommendations of the American Heart Association. Brachial-ankle pulse wave velocity (BaPWV) ≥ 1400 cm/s was employed to evaluate increased arterial stiffness. Multivariate regression models were used to compare the different effects of BMI and VFA on arterial stiffness.
Lower VFA was more strongly associated with low BaPWV than lower BMI when other ICVHMs were included (adjusted odds ratio [OR], 0.85 [95% confidence interval [CI], 0.80-0.90] vs OR 1.08 [95% CI, 1.00-1.17]). Multivariable-adjusted ORs for arterial stiffness were highest in patients with the VAT area VFA in the range of 150-200 cm (adjusted OR, 1.26 [95% CI 1.12-1.41]). Compared with participants with VAT VFA < 100 cm , among participants with higher VAT VFA, the OR for arterial stiffness decreased gradually from 1.89 (95% CI, 1.73-2.07) in patients who had ≤1 ICVHM to 0.39 (95% CI, 0.25-0.62) in patients who had ≥5 ICVHMs.
In patients with T2DM, using VAT for anthropometric measures of obesity, VFA was more relevant to cardiovascular risk than BMI in the seven ICVHMs. For anthropometric measures of obesity in the ICVHMs to describe cardiovascular risk VFA would be more optimal than BMI.
在 2 型糖尿病（T2DM）患者中，当使用体重指数（BMI）来定义肥胖时，会出现“肥胖悖论”。我们研究了内脏脂肪面积（VFA）作为肥胖测量指标与七个理想心血管健康指标（ICVHMs）中动脉僵硬的相关性。
从 2017 年 6 月至 2021 年 4 月，在 10 个国家代谢管理中心的 29048 名患者中进行了分析。ICVHMs 是根据美国心脏协会的建议进行修改的。肱踝脉搏波速度（BaPWV）≥1400cm/s 用于评估动脉僵硬程度。使用多元回归模型比较 BMI 和 VFA 对动脉僵硬的不同影响。
当纳入其他 ICVHMs 时，较低的 VFA 与较低的 BaPWV 相关性更强，而不是较低的 BMI（校正比值比 [OR]，0.85 [95%置信区间 [CI]，0.80-0.90] vs OR 1.08 [95% CI，1.00-1.17]）。动脉僵硬的多变量校正 OR 在 VAT 区 VFA 范围为 150-200cm 的患者中最高（校正 OR，1.26 [95% CI 1.12-1.41]）。与 VAT VFA<100cm 的参与者相比，在具有较高 VAT VFA 的参与者中，动脉僵硬的 OR 逐渐从具有≤1 个 ICVHM 的患者的 1.89（95%CI，1.73-2.07）降低到具有≥5 个 ICVHMs 的患者的 0.39（95%CI，0.25-0.62）。
在 T2DM 患者中，使用 VAT 作为肥胖的人体测量指标时，VFA 在七个 ICVHMs 中比 BMI 更与心血管风险相关。对于 ICVHMs 中的肥胖人体测量指标，VFA 比 BMI 更能描述心血管风险。
