Correlation of Chinese visceral adipose index and visceral fat area with diabetic nephropathy and their warning values

doi:10.3969/j.issn.1004-583X.2022.12.004

Abstract

Abstract:

Objective To explore the correlation between Chinese visceral adipose index (CVAI) and visceral fat area (VFA) with diabetes nephropathy (DN) in Chinese population, and their values of early warning. Methods Clinical data of 240 patients with type 2 diabetes (T2DM) hospitalized in the Department of Endocrinology of Gansu Provincial People's Hospital from October 2020 to October 2021 were retrospectively analyzed, including the baseline characteristics, physical examination findings, and biochemical indicators. They were divided into DN group (n=114) and non-DN group (n=126) according to the presence or absence of DN. The correlation between CVAI and VFA with urinary albumin excretion rate (UAER), urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) was assessed by the Spearman’s correlation test. Independent risk factors of DN in T2DM patients were screened by multivariatestepwise logistic regression analysis, and a multivariate logistic regression model was created. The predictive value of the model and each risk factor was evaluated by plotting the receiver operating characteristic (ROC) curve. Results Compared with those of the non-DN group, patients in DN group presented significantly longer duration of diabetes, larger weight, body mass index, waist circumference, hip circumference, waist height ratio, waist hip ratio, and neck circumference, and higher fasting plasma glucose (FPG), urinary albumin excretion rate (UAER), urine albumin-creatinine ratio (UACR), glycosylated hemoglobin(HbA₁c), lipid accumulation production, CVAI, VFA and subcutaneous fat area, and lower estimated glomerular filtration rate (eGFR) (all P<0.05). Spearman’s correlation test showed that UAER and UACR were positively correlated with CVAI and VFA (all P<0.05). Logistic regression analysis showed that CVAI, VFA, FPG and the course of diabetes were independent risk factors for DN in T2DM patients (all P<0.05). ROC curve analysis showed that the area under the curve (AUC), sensitivity and specificity of CVAI were 0.6730, 0.3947, and 0.881, respectively, which of VFA were 0.6453, 0.7456, and 0.4921, respectively. Besides, AUC, sensitivity and specificity of the created logistic regression model were 0.7493, 0.7368, and 0.6825, respectively. The predictive potential of the logistic regression model was better than that of a single independent risk factor. Conclusion CVAI, VFA, FPG and the course of diabetes are independent risk factors for DN in T2DM patients. CVAI and VFA can be used as early warning indicators for DN in T2DM patients, providing an important basis for the management of visceral obesity patients.

Key words: diabetic nephropathies, visceral fat area, Chinese visceral adipose index, risk factors

CLC Number:

R587.24

He Feng, Nin Lu, Luo Gao, Yang Ruifei, Li Fanfan, Cheng Xiaoqiong, An Binbin, Li Jingjuan, Liu Yuanyuan, Guo Qian, Wang Jinyang. Correlation of Chinese visceral adipose index and visceral fat area with diabetic nephropathy and their warning values[J]. Clinical Focus, 2022, 37(12): 1089-1093.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.12.004

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I12/1089

Figures/Tables 9

组别	例数	性别[例(%)]		年龄(岁)	糖尿病病程
组别	例数	男	女	年龄(岁)	糖尿病病程
非DN组	126	74(58.7)	52(41.3)	57.25±10.11	3.00(1.00, 10.00)
DN组	114	75(65.8)	39(34.2)	56.71±12.47	7.00(2.00, 12.50)
统计值		χ²=1.267		t=0.367	$Z$ =-2.149
P值		0.260		0.714	0.032

组别	例数	性别[例(%)]		年龄(岁)	糖尿病病程
组别	例数	男	女	年龄(岁)	糖尿病病程
非DN组	126	74(58.7)	52(41.3)	57.25±10.11	3.00(1.00, 10.00)
DN组	114	75(65.8)	39(34.2)	56.71±12.47	7.00(2.00, 12.50)
统计值		χ²=1.267		t=0.367	$Z$ =-2.149
P值		0.260		0.714	0.032

组别	例数	收缩压(mmHg)	舒张压(mmHg)	颈围(cm)		身高(cm)		体重(kg)
非DN组	126	130.00(117.75, 140.25)	81.24±9.58	36.55(34.00, 38.70)		167.50(160.00, 170.25)		67.50(59.75, 75.00)
DN组	114	133.00(119.50, 147.50)	82.22±13.30	38.00(35.10, 40.50)		168.00(160.00, 172.00)		70.50(63.88, 80.25)
统计值		$Z$ =-1.769	t=-2.006	$Z$ =-3.114		$Z$ =-1.227		$Z$ =-3.252
P值		0.077	0.050	0.002		0.220		0.001
组别	例数	BMI(kg/m²)	WC(cm)		臀围(cm)		腰高比		腰臀比
非DN组	126	24.06(22.19, 26.22)	90.00(83.00, 95.00)		95.00(90.00, 98.78)		0.54(0.50, 0.57)		0.94(0.90, 0.97)
DN组	114	25.34(23.52, 27.66)	97.00(90.00, 102.00)		98.00(93.00, 103.55)		0.57(0.53, 0.61)		0.97(0.933, 1.01)
统计值		$Z$ =-3.152	$Z$ =-5.563		$Z$ =-3.284		$Z$ =-5.163		$Z$ =-4.661
P值		0.002	0.000		0.001		0.000		0.000

组别	例数	收缩压(mmHg)	舒张压(mmHg)	颈围(cm)		身高(cm)		体重(kg)
非DN组	126	130.00(117.75, 140.25)	81.24±9.58	36.55(34.00, 38.70)		167.50(160.00, 170.25)		67.50(59.75, 75.00)
DN组	114	133.00(119.50, 147.50)	82.22±13.30	38.00(35.10, 40.50)		168.00(160.00, 172.00)		70.50(63.88, 80.25)
统计值		$Z$ =-1.769	t=-2.006	$Z$ =-3.114		$Z$ =-1.227		$Z$ =-3.252
P值		0.077	0.050	0.002		0.220		0.001
组别	例数	BMI(kg/m²)	WC(cm)		臀围(cm)		腰高比		腰臀比
非DN组	126	24.06(22.19, 26.22)	90.00(83.00, 95.00)		95.00(90.00, 98.78)		0.54(0.50, 0.57)		0.94(0.90, 0.97)
DN组	114	25.34(23.52, 27.66)	97.00(90.00, 102.00)		98.00(93.00, 103.55)		0.57(0.53, 0.61)		0.97(0.933, 1.01)
统计值		$Z$ =-3.152	$Z$ =-5.563		$Z$ =-3.284		$Z$ =-5.163		$Z$ =-4.661
P值		0.002	0.000		0.001		0.000		0.000

组别	例数		总胆固醇(mmol/L)		TG(mmol/L)		LDL-C(mmol/L)		HDL-C(mmol/L)		FPG(mmol/L)
非DN组	126		4.47(3.70, 5.16)		1.63(1.18, 2.75)		2.57±0.83		1.01(0.87, 1.18)		8.24(6.43, 11.32)
DN组	114		4.42(3.80, 5.26)		1.85(1.29, 3.11)		2.68±0.76		0.97(0.84, 1.10)		9.29(7.16, 13.46)
统计值			$Z$ =-0.703		$Z$ =-1.633		t=-1.042		$Z$ =-1.342		$Z$ =-2.683
P值			0.482		0.102		0.299		0.180		0.007
组别		例数		UAER		UACR		eGFR[ml/ (min·1.73 m²)]		HbA₁c(%)
非DN组		126		11.46(8.05, 15.50)		14.47(9.42, 23.56)		98.13(89.25, 105.19)		8.30(6.90, 10.02)
DN组		114		45.42(27.17, 100.12)		53.802(34.56, 115.70)		92.98(79.64, 104.92)		8.70(7.450, 10.75)
统计值				$Z$ =-13.372		$Z$ =-12.360		$Z$ =-2.305		$Z$ =-1.780
P值				0.000		0.000		0.021		0.075

组别	例数		总胆固醇(mmol/L)		TG(mmol/L)		LDL-C(mmol/L)		HDL-C(mmol/L)		FPG(mmol/L)
非DN组	126		4.47(3.70, 5.16)		1.63(1.18, 2.75)		2.57±0.83		1.01(0.87, 1.18)		8.24(6.43, 11.32)
DN组	114		4.42(3.80, 5.26)		1.85(1.29, 3.11)		2.68±0.76		0.97(0.84, 1.10)		9.29(7.16, 13.46)
统计值			$Z$ =-0.703		$Z$ =-1.633		t=-1.042		$Z$ =-1.342		$Z$ =-2.683
P值			0.482		0.102		0.299		0.180		0.007
组别		例数		UAER		UACR		eGFR[ml/ (min·1.73 m²)]		HbA₁c(%)
非DN组		126		11.46(8.05, 15.50)		14.47(9.42, 23.56)		98.13(89.25, 105.19)		8.30(6.90, 10.02)
DN组		114		45.42(27.17, 100.12)		53.802(34.56, 115.70)		92.98(79.64, 104.92)		8.70(7.450, 10.75)
统计值				$Z$ =-13.372		$Z$ =-12.360		$Z$ =-2.305		$Z$ =-1.780
P值				0.000		0.000		0.021		0.075

组别	例数	LAP	CVAI	VFA(cm²)	SFA(cm²)
非DN组	126	43.79(27.14, 81.02)	120.51(97.10, 140.95)	97.50(70.75, 120.00)	176.00(147.75, 224.00)
DN组	114	59.67(41.29, 108.71)	139.05(112.76,163.92)	114.00(96.00,137.00)	209.00(170.00, 252.50)
$Z$ 值		-3.475	-4.627	-3.886	-2.955
P值		0.001	0.000	0.000	0.003

组别	例数	LAP	CVAI	VFA(cm²)	SFA(cm²)
非DN组	126	43.79(27.14, 81.02)	120.51(97.10, 140.95)	97.50(70.75, 120.00)	176.00(147.75, 224.00)
DN组	114	59.67(41.29, 108.71)	139.05(112.76,163.92)	114.00(96.00,137.00)	209.00(170.00, 252.50)
$Z$ 值		-3.475	-4.627	-3.886	-2.955
P值		0.001	0.000	0.000	0.003

因变量	CVAI		VFA
因变量	$r s$ 值	P值	$r s$ 值	P值
UAER	0.258	0.000	0.209	0.001
UACR	0.196	0.002	0.128	0.048
eGFR	-0.116	0.073	0.013	0.843

因变量	CVAI		VFA
因变量	$r s$ 值	P值	$r s$ 值	P值
UAER	0.258	0.000	0.209	0.001
UACR	0.196	0.002	0.128	0.048
eGFR	-0.116	0.073	0.013	0.843

因素	回归系数	标准误	Wald χ²值	P值	$O R$ 值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	$O R$ 值	下限	上限
CVAI	0.015	0.005	8.167	0.004	1.015	1.005	1.025
FPG	0.123	0.037	11.023	0.001	1.131	1.052	1.216
VFA	0.010	0.005	4.101	0.043	1.010	1.000	1.020
糖尿病病程	0.057	0.021	7.073	0.008	1.058	1.015	1.104
常量	-4.737	0.809	34.260	0.000	0.009

因素	回归系数	标准误	Wald χ²值	P值	$O R$ 值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	$O R$ 值	下限	上限
CVAI	0.015	0.005	8.167	0.004	1.015	1.005	1.025
FPG	0.123	0.037	11.023	0.001	1.131	1.052	1.216
VFA	0.010	0.005	4.101	0.043	1.010	1.000	1.020
糖尿病病程	0.057	0.021	7.073	0.008	1.058	1.015	1.104
常量	-4.737	0.809	34.260	0.000	0.009

预测项目	AUC	标准误	P值	95%CI		敏感度	特异度	约登指数	界值
预测项目	AUC	标准误	P值	下限	上限	敏感度	特异度	约登指数	界值
CVAI	0.6730	0.03465	0.0001	0.605	0.741	0.3947	0.8810	0.2757	154.45
VFA	0.6453	0.03555	0.0073	0.576	0.715	0.7456	0.4921	0.2377	96.50
FPG	0.6003	0.03647	0.0320	0.529	0.672	0.7544	0.4127	0.1671	7.25
糖尿病病程	0.5802	0.03686	0.0001	0.508	0.652	0.6667	0.5159	0.4193	3.50
多因素logistic回归模型	0.7493	0.03157	0.0001	0.687	0.811	0.7368	0.6825	0.4193	0.44

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