Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil.
RDO Diagnósticos Médicos, Brazil.
Bone. 2025 Jan;190:117308. doi: 10.1016/j.bone.2024.117308. Epub 2024 Oct 30.
While visceral fat measured by dual-energy X-ray absorptiometry (DXA) is accurate in identifying middle-aged people at increased cardiometabolic risk, consistent data for the elderly are still lacking. We aimed to investigate the association between DXA-derived visceral adipose tissue (VAT) and metabolic syndrome (MetS) and to establish optimal cutoffs for VAT to predict MetS in a low-income elderly Brazilian cohort. A total of 449 women and 258 men (≥65 years) from the community were enrolled in this study. Participants underwent clinical and laboratory evaluations, along with body composition analysis by Hologic Discovery A densitometer. VAT was measured in the android region of the DXA scan. MetS was diagnosed using NCEP-ATPIII criteria. Multivariate logistic regression analyzed the relationship between VAT and MetS. Receiver-operating characteristic (ROC) curve analysis evaluated VAT's predictive accuracy for MetS, with optimal cutoffs determined by Youden's test to balance sensitivity and specificity. Mean ages were 76.6 ± 4.7 years for men and 77.1 ± 4.9 years for women. Mean BMIs were 26.5 ± 3.8 kg/m for men and 29.0 ± 5.2 kg/m for women. One hundred and seventy-five (41.5 %) men and 274 (61 %) women had MetS. After adjustments for confounders, multivariate analysis showed that VAT was independently associated with MetS in both men (OR 1.41, 95%CI 1.15-1.72) and women (OR 1.33, 95%CI 1.16-1.54, per each 100 g increase). Optimal VAT cutoffs to predict MetS were 642.5 g for men (AUC = 0.740) and 600.5 g for women (AUC = 0.729). Subanalysis for non-overweight/non-obese subjects yielded lower VAT cutoffs. Thus, VAT measured by DXA was significantly associated with MetS in older adults, regardless of BMI, emphasizing the critical role of VAT in predicting MetS. Therefore, VAT by DXA holds promise for evaluating MetS risk in the elderly. Further longitudinal studies are needed to investigate VAT's impact on major cardiovascular event incidence in this demographic.
虽然双能 X 射线吸收法 (DXA) 测量的内脏脂肪能准确识别心血管代谢风险增加的中年人，但老年人的数据仍然缺乏。我们旨在研究 DXA 衍生的内脏脂肪组织 (VAT) 与代谢综合征 (MetS) 的相关性，并为巴西低收入老年人群确定预测 MetS 的最佳 VAT 截断值。这项研究共纳入了社区的 449 名女性和 258 名男性（年龄≥65 岁）。参与者接受了临床和实验室评估，以及霍洛威发现 A 密度仪进行的身体成分分析。DXA 扫描的安卓区域测量了 VAT。采用 NCEP-ATPIII 标准诊断 MetS。多变量逻辑回归分析了 VAT 与 MetS 之间的关系。接受者操作特征 (ROC) 曲线分析评估了 VAT 预测 MetS 的准确性，通过 Youden 检验确定最佳截断值以平衡敏感性和特异性。男性的平均年龄为 76.6±4.7 岁，女性为 77.1±4.9 岁。男性的平均 BMI 为 26.5±3.8kg/m，女性为 29.0±5.2kg/m。175 名男性（41.5%）和 274 名女性（61%）患有 MetS。调整混杂因素后，多变量分析显示，VAT 与男性（OR 1.41，95%CI 1.15-1.72）和女性（OR 1.33，95%CI 1.16-1.54，每增加 100g）的 MetS 均独立相关。预测 MetS 的最佳 VAT 截断值为男性 642.5g（AUC=0.740）和女性 600.5g（AUC=0.729）。对非超重/非肥胖受试者的亚组分析得出了较低的 VAT 截断值。因此，DXA 测量的 VAT 与老年人的 MetS 显著相关，与 BMI 无关，这强调了 VAT 在预测 MetS 中的关键作用。因此，DXA 测量的 VAT 有望用于评估老年人的 MetS 风险。需要进一步的纵向研究来调查该人群中 VAT 对主要心血管事件发生率的影响。
