非肥胖型2型糖尿病患者中与内脏脂肪相关的人体测量和代谢参数。
Anthropometric and metabolic parameters associated with visceral fat in non-obese type 2 diabetes individuals.
作者信息
Jiao Ming, Chen Jiaoli, Wang Xiaoling, Tao Wenyu, Feng Yunhua, Yang Huijun, Yang Haiying, Zhao Shanshan, Yang Ying, Li Yiping
机构信息
Department of Endocrinology, The Second People's Hospital of Yunnan Province, The Affiliated Hospital of Yunnan University, Kunming, Yunnan, 650021, China.
Kunming Medical University, Kunming, Yunnan, 650021, China.
出版信息
Diabetol Metab Syndr. 2025 Jan 22;17(1):28. doi: 10.1186/s13098-025-01583-1.
BACKGROUND AND AIM
Visceral fat (VF) was proved to be a more precise predictor of atherosclerotic cardiovascular disease (ASCVD) risk in individuals with type 2 diabetes mellitus (T2DM) than body mass index (BMI) itself. Even when the BMI was normal, visceral fat area (VFA) ≥ 90 cm² could raise the ten-year risk of developing ASCVD. Therefore, it was worth evaluating the association of influencing factors with high VF in non-obese T2DM individuals.
METHODS
This study enrolled 1,409 T2DM participants with T2DM, of whom 538 had a normal BMI. Based on VFA, these subjects were divided into two groups: VF (+) (VFA ≥ 90cm) (n = 110) and VF (-) (VFA < 90cm) (n = 428). The measurement of VFA was conducted using an Omron VF measuring device. Anthropometric and metabolic parameters were detected. Novel insulin resistance indices, such as lipid accumulation product (LAP) was calculated. Factors associated with VF were screened using univariate analysis, multifactorial binary logistic regression models and chi-squared automatic interaction detector decision tree model.
RESULTS
The VF (+) OB (-) (BMI ≤ 23.9 kg/m) prevalence were 7.8% in T2DM subjects (n = 1,409) and 20.4% in T2DM subjects with normal BMI (n = 538), respectively. In T2DM subjects with normal BMI, the logistic regression model suggested that neck circumference (NC) had an odds ratio (OR) of 1.891 (95% CI: 1.165-3.069, P = 0.010). The OR for VF gradually increased from the 1st to the 4th in LAP quartile (P < 0.05). LAP emerged as the root node, followed by NC in the decision tree model. Receiver operating characteristic curve (ROC) analysis demonstrated that the area under the curve (AUC) for NC in predicting high VF levels was 0.640 for males and 0.682 for females. Optimal NC cut-off points were 37.75 cm for males and 34.75 cm for females, respectively. Additionally, the AUC values of LAP in predicting high VF levels were 0.745 for males and 0.772 for females, with optimal LAP cut-off points of 22.64 and 26.45 for males and females, respectively.
CONCLUSION
This study identified NC and LAP can be considered predictors of high VF in T2DM subjects with normal BMI.
背景与目的
事实证明，对于2型糖尿病（T2DM）患者，内脏脂肪（VF）比体重指数（BMI）本身更能精准预测动脉粥样硬化性心血管疾病（ASCVD）风险。即使BMI正常，内脏脂肪面积（VFA）≥90 cm²也会增加患ASCVD的十年风险。因此，评估非肥胖T2DM患者中影响高VF的因素之间的关联很有必要。
方法
本研究纳入了1409例T2DM患者，其中538例BMI正常。根据VFA，将这些受试者分为两组：VF（+）（VFA≥90cm）（n = 110）和VF（-）（VFA < 90cm）（n = 428）。使用欧姆龙VF测量设备测量VFA。检测人体测量和代谢参数。计算新型胰岛素抵抗指数，如脂质蓄积产物（LAP）。采用单因素分析、多因素二元逻辑回归模型和卡方自动交互检测决策树模型筛选与VF相关的因素。
结果
T2DM患者（n = 1409）中VF（+）OB（-）（BMI≤23.9 kg/m）的患病率为7.8%，BMI正常的T2DM患者（n = 538）中为20.4%。在BMI正常的T2DM患者中，逻辑回归模型显示颈围（NC）的比值比（OR）为1.891（95%CI：1.165 - 3.069，P = 0.010）。在LAP四分位数中，VF的OR从第1组到第4组逐渐增加（P < 0.05）。在决策树模型中，LAP作为根节点，其次是NC。受试者工作特征曲线（ROC）分析表明，NC预测高VF水平时，男性的曲线下面积（AUC）为0.640，女性为0.682。男性的最佳NC切点为37.75 cm，女性为34.75 cm。此外，LAP预测高VF水平时，男性的AUC值为0.745，女性为0.772，男性和女性的最佳LAP切点分别为22.64和26.45。
结论
本研究确定NC和LAP可被视为BMI正常的T2DM患者高VF的预测指标。
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