Nagayama Daiji, Watanabe Yasuhiro, Shirai Kohji, Ohira Masahiro, Saiki Atsuhito
Department of Internal Medicine, Nagayama Clinic, 323-0032 Oyama, Tochigi, Japan.
Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, 285-0841 Sakura, Chiba, Japan.
Rev Cardiovasc Med. 2025 Mar 18;26(3):26583. doi: 10.31083/RCM26583. eCollection 2025 Mar.
Waist circumference (WC), an abdominal obesity index in the current metabolic syndrome (MetS) criteria, may not adequately reflect visceral fat accumulation. This brief review aims to examine the clinical significance of utilizing a body shape index (ABSI), a novel abdominal obesity index, to modify the MetS criteria, considering the predictive ability for vascular dysfunction indicated by the cardio-ankle vascular index (CAVI), as well as kidney function decline. First, the relationship of CAVI with kidney function is presented. Next, whether modification of the MetS diagnostic criteria by replacing the current high waist circumference (WC-MetS) with high ABSI (ABSI-MetS) improves the predictive ability for vascular and kidney dysfunction is discussed. Although limited to Asian populations, several cross-sectional and longitudinal studies support the relationship of CAVI with kidney function. Increased CAVI is associated with kidney function decline, and the CAVI cutoff for kidney outcomes is considered to be 8-9. In urban residents who underwent health screening, an increase in ABSI, but not body mass index (BMI) or WC, was associated with increased CAVI, suggesting that ABSI reflects vasoinjurious body composition. In several cross-sectional studies, ABSI-MetS was superior to WC-MetS in identifying individuals with increased CAVI. Furthermore, the predictive ability of ABSI-MetS in assessing kidney function decline was enhanced only in individuals with MetS, as determined in a longitudinal analysis. Using WC as a major criterion for MetS diagnosis may not adequately identify individuals at risk of vascular dysfunction and kidney function decline. This review shows that this problem may be solved by replacing WC with ABSI. Future research should explore whether ABSI-MetS also predicts cardiovascular events, and whether therapeutic intervention that reduces ABSI improves clinical outcomes.
腰围（WC）是当前代谢综合征（MetS）标准中的腹部肥胖指标，可能无法充分反映内脏脂肪堆积情况。本简要综述旨在探讨使用体型指数（ABSI）这一新型腹部肥胖指标来修正MetS标准的临床意义，同时考虑到心踝血管指数（CAVI）所表明的血管功能障碍的预测能力以及肾功能下降情况。首先，阐述了CAVI与肾功能的关系。接下来，讨论了用高ABSI（ABSI-MetS）取代当前的高腰围（WC-MetS）来修正MetS诊断标准是否能提高对血管和肾功能障碍的预测能力。尽管限于亚洲人群，但多项横断面和纵向研究支持了CAVI与肾功能的关系。CAVI升高与肾功能下降相关，肾功能结局的CAVI临界值被认为是8 - 9。在接受健康筛查的城市居民中，ABSI升高而非体重指数（BMI）或WC升高与CAVI升高相关，这表明ABSI反映了具有血管损伤作用的身体组成。在多项横断面研究中，ABSI-MetS在识别CAVI升高的个体方面优于WC-MetS。此外，纵向分析确定，仅在患有MetS的个体中，ABSI-MetS评估肾功能下降的预测能力有所增强。将WC用作MetS诊断的主要标准可能无法充分识别有血管功能障碍和肾功能下降风险的个体。本综述表明，用ABSI取代WC可能解决这一问题。未来的研究应探索ABSI-MetS是否也能预测心血管事件，以及降低ABSI的治疗干预是否能改善临床结局。
