3.1 Baseline Characteristics
The strategy that led to the inclusion of the 11,214 subjects of this study is shown in Figure 1. Baseline characteristics of the participants are shown in Table 1. The participants were divided into four groups based on VAI quartiles; the values of VAI in these quartiles (as mean ± SD) were Q1, 0.59±0.00; Q2, 1.10±0.00; Q3, 1.79±0.01; and Q4, 3.74±0.04. The weighted mean age of the participants was 47.65±0.29 years. Among the study participants, 49.00% were male, and 51.00% were female. Compared with subjects in Q1, subjects in Q4 were higher in age and more likely to be female and to belong to the non-Hispanic white demographic. As compared with subjects in Q1, subjects in Q4 had a higher average level of education, were more likely to be married, were more likely to be non-smokers and to not consume alcohol. In addition, subjects in Q4 had higher levels of BMI, WC, PIR、FDG, HbA1c, TC, TG, LDL, ALT, and AST, and higher levels of hypertension, coronary heart disease, stroke, and heart failure. As compared with subjects in Q1, subjects in Q4 were less likely to belong to the physical activity , and they had lower levels of eGFR and HDL. Differences in age, race, education, marriage, PIR,smoking, alcohol consumption, BMI, WC, FDG, HbA1c, TC, TG, LDL, HDL, eGFR, AST, AST, physical activity,hypertension, coronary artery disease and heart failure were statistically significant among all four quartiles (p < 0.05).
TABLE 1 | Baseline information for the included participants according to Visceral Adiposity Index quartiles .
Variable
|
Total
(n=11214)
|
Q1
(n=2803)
|
Q2
(n=2803)
|
Q3
(n=2802)
|
Q4
(n=2806)
|
P-value
|
Age, years
|
47.65±0.29
|
44.72±0.59
|
46.91±0.39
|
48.83±0.42
|
50.25±0.40
|
< 0.0001
|
Gender, n(%)
|
|
|
|
|
|
0.15
|
Female
|
5657(50.60)
|
1323(48.40)
|
1420(50.84)
|
1438(52.27)
|
1476(51.00)
|
|
Male
|
5557(49.40)
|
1480(51.60)
|
1383(49.16)
|
1364(47.73)
|
1330(49.00)
|
|
Race, n(%)
|
|
|
|
|
|
< 0.0001
|
Mexican American
|
1655( 8.08)
|
263(5.83)
|
375(7.54)
|
492(9.31)
|
525(9.75)
|
|
Non-Hispanic Black
|
2192( 9.76)
|
846(14.94)
|
630(11.02)
|
436( 7.90)
|
280( 4.95)
|
|
Non-Hispanic White
|
4966(69.69)
|
1122(67.04)
|
1213(69.53)
|
1243(69.26)
|
1388(72.99)
|
|
Other Race
|
1252( 7.11)
|
360(7.69)
|
300(6.25)
|
315(7.86)
|
277(6.63)
|
|
Others
|
1149( 5.37)
|
212(4.50)
|
285(5.66)
|
316(5.67)
|
336(5.68)
|
|
Education, n(%)
|
|
|
|
|
|
< 0.0001
|
9-11th grade
|
1553(10.20)
|
335( 7.79)
|
352( 9.34)
|
411(11.29)
|
455(12.48)
|
|
College graduate or above
|
2791(31.56)
|
905(40.84)
|
749(31.91)
|
630(28.11)
|
507(24.97)
|
|
High school graduate
|
2545(22.60)
|
559(19.17)
|
654(23.50)
|
649(22.37)
|
683(25.48)
|
|
Less than 9th grade
|
1015( 4.63)
|
156(3.15)
|
226(4.17)
|
281(4.89)
|
352(6.35)
|
|
Some College
|
3310(31.02)
|
848(29.04)
|
822(31.09)
|
831(33.34)
|
809(30.73)
|
|
Marital status, n(%)
|
|
|
|
|
|
< 0.0001
|
Divorced
|
1253(10.61)
|
268( 8.69)
|
326(11.18)
|
306(10.86)
|
353(11.79)
|
|
Living with partner
|
917( 8.08)
|
252(9.00)
|
229(7.84)
|
213(8.10)
|
223(7.35)
|
|
Married
|
5831(56.23)
|
1339(54.25)
|
1434(54.84)
|
1518(56.41)
|
1540(59.48)
|
|
Never married
|
2018(17.68)
|
694(22.29)
|
535(19.02)
|
451(17.20)
|
338(12.05)
|
|
Separated
|
371( 2.12)
|
85(1.64)
|
91(2.44)
|
95(2.02)
|
100(2.39)
|
|
Widowed
|
824( 5.28)
|
165(4.12)
|
188(4.68)
|
219(5.42)
|
252(6.94)
|
|
PIR
|
|
|
|
|
|
< 0.0001
|
<1.30
|
3450(20.75)
|
741(17.68)
|
803(19.82)
|
879(21.25)
|
1027(24.34)
|
|
1.30-3.50
|
4262(35.48)
|
1073(34.20)
|
1069(34.90)
|
1083(37.34)
|
1037(35.58)
|
|
>=3.50
|
3502(43.77)
|
989(48.12)
|
931(45.27)
|
840(41.41)
|
742(40.08)
|
|
eGFR, mL/min/1.73 m2
|
94.92±0.37
|
98.52±0.68
|
95.51±0.52
|
93.54±0.54
|
91.95±0.61
|
< 0.0001
|
BMI, kg/m2
|
28.97±0.11
|
25.78±0.15
|
28.21±0.18
|
30.17±0.17
|
31.86±0.16
|
< 0.0001
|
WC, cm
|
99.36±0.27
|
90.36±0.36
|
97.09±0.46
|
102.70±0.37
|
107.66±0.42
|
< 0.0001
|
FPG, mmol/L
|
5.90±0.02
|
5.53±0.03
|
5.67±0.03
|
5.96±0.04
|
6.46±0.06
|
< 0.0001
|
HbA1c, %
|
5.62±0.01
|
5.41±0.02
|
5.51±0.01
|
5.67±0.02
|
5.91±0.04
|
< 0.0001
|
Physical Activity,METs
|
3853.99±93.58
|
4761.67±191.08
|
3857.54±122.79
|
3531.08±148.04
|
3228.47±139.02
|
< 0.0001
|
TC, mmol/L
|
4.98±0.02
|
4.75±0.03
|
4.91±0.02
|
4.99±0.03
|
5.29±0.03
|
< 0.0001
|
TG, mmol/L
|
1.37±0.01
|
0.68±0.01
|
1.02±0.01
|
1.40±0.01
|
2.39±0.02
|
< 0.0001
|
HDL, mmol/L
|
1.41±0.01
|
1.77±0.01
|
1.48±0.01
|
1.29±0.01
|
1.08±0.01
|
< 0.0001
|
LDL, mmol/L
|
2.95±0.01
|
2.64±0.02
|
2.96±0.02
|
3.07±0.02
|
3.15±0.02
|
< 0.0001
|
Alt, U/L
|
25.10±0.21
|
22.39±0.49
|
23.88±0.41
|
25.26±0.32
|
28.94±0.40
|
< 0.0001
|
Ast, U/L
|
25.08±0.19
|
25.10±0.42
|
24.59±0.35
|
24.45±0.29
|
26.17±0.44
|
0.01
|
VAI
|
1.80±0.02
|
0.59±0.00
|
1.10±0.00
|
1.79±0.01
|
3.74±0.04
|
< 0.0001
|
Smoking status, n(%)
|
|
|
|
|
|
< 0.0001
|
Former
|
2773(25.70)
|
622(23.68)
|
665(24.38)
|
727(27.05)
|
759(27.79)
|
|
Never
|
6179(55.28)
|
1708(61.32)
|
1605(57.89)
|
1509(52.83)
|
1357(48.82)
|
|
Now
|
2262(19.02)
|
473(14.99)
|
533(17.73)
|
566(20.11)
|
690(23.39)
|
|
Alcohol use, n(%)
|
|
|
|
|
|
< 0.0001
|
Former
|
1713(12.51)
|
321( 8.82)
|
369(11.01)
|
464(13.63)
|
559(16.71)
|
|
Heavy
|
2293(21.05)
|
543(19.76)
|
593(22.58)
|
594(21.91)
|
563(20.01)
|
|
Mild
|
3958(38.46)
|
1089(41.34)
|
1020(38.30)
|
944(36.47)
|
905(37.58)
|
|
Moderate
|
1757(17.83)
|
515(21.00)
|
446(17.22)
|
414(17.64)
|
382(15.36)
|
|
Never
|
1493(10.15)
|
335( 9.07)
|
375(10.89)
|
386(10.34)
|
397(10.34)
|
|
Hypertension, n(%)
|
|
|
|
|
|
< 0.0001
|
No
|
6492(62.23)
|
1901(74.31)
|
1693(65.29)
|
1526(58.64)
|
1372(50.22)
|
|
Yes
|
4722(37.77)
|
902(25.69)
|
1110(34.71)
|
1276(41.36)
|
1434(49.78)
|
|
Stroke, n(%)
|
|
|
|
|
|
0.08
|
No
|
10785(97.10)
|
2721(97.89)
|
2693(97.19)
|
2697(96.87)
|
2674(96.43)
|
|
Yes
|
429( 2.90)
|
82(2.11)
|
110(2.81)
|
105(3.13)
|
132(3.57)
|
|
CHD, n(%)
|
|
|
|
|
|
< 0.001
|
No
|
10766(96.52)
|
2720(97.31)
|
2701(97.12)
|
2688(96.73)
|
2657(94.91)
|
|
Yes
|
448( 3.48)
|
83(2.69)
|
102(2.88)
|
114(3.27)
|
149(5.09)
|
|
HF, n(%)
|
|
|
|
|
|
< 0.0001
|
No
|
10889(97.74)
|
2752(98.77)
|
2732(98.24)
|
2725(97.93)
|
2680(96.00)
|
|
Yes
|
325( 2.26)
|
51(1.23)
|
71(1.76)
|
77(2.07)
|
126(4.00)
|
|
DM, n(%)
|
|
|
|
|
|
< 0.0001
|
No
|
8881(84.17)
|
2490(92.67)
|
2367(89.39)
|
2130(81.66)
|
1894(72.65)
|
|
Yes
|
2333(15.83)
|
313( 7.33)
|
436(10.61)
|
672(18.34)
|
912(27.35)
|
|
Abbreviations: quartile of Visceral Adiposity Index (VAI), Q1(≤0.849), Q2(0.849<VAI≤1.379), Q3(1.379<VAI≤2.324), Q4(>2.324); Income to poverty ratio(PIR),eGFR, estimated glomerular filtration rate; BMI, body mass index; WC, waist circumference; FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; LDL-c, low-density lipoprotein-cholesterol; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CHD, coronary heart disease; HF, heart failure; DM, diabetes mellitus.
3.2Relationship between VAI and T2DM
Logistic regression models were used to analyze the correlation among VAI and the prevalence of T2DM as shown in Table 2.In fully adjusted continuous models, the prevalence of T2DM in the total population increased 0.43-fold with each 1-unit increase in VAI [(OR) =1.43; 95% (CI) 1.35-1.50]. In the fully adjusted categorical model with VAI scores stratified by quartiles,the results showed a higher T2DM advantage for participants in the second, third, and fourth quartiles (Q2: OR 1.35, 95% CI 1.06-1.71; Q3: OR 2.46, 95% CI 1.95-3.11; Q4: OR 4.42, 95% CI 3.55-05.50 ). The prevalence of T2DM in the total population increased 3.42-fold in Q4 compared to Q1.A trend test was performed to ensure the stability of the results of this study, and the incidence of VAI and T2DM showed a monotonically increasing trend in all models (P<0.0001). In summary, it can be seen that VAI was positively correlated with the incidence of T2DM. We plotted a smoothed curve fit as shown in Figure 2, and after adjusting for confounders such as age, sex, race, education, marriage, PIR, smoking, alcohol consumption, physical activity, eGFR, AST, AST, TC, LDL, hypertension, coronary heart disease, stroke, and heart failure, we found that VAI and T2DM prevalence were consistent and nonlinearly associated with multifactorial logistic regression ( P for non-near= 0 < 0.05).
TABLE 2 | The association between VAI and IR in a multiple logistics regression model.
Character
|
Model 1
|
Model 2
|
Model 3
|
95%CI
|
P
|
95%CI
|
P
|
95%CI
|
P
|
VAI
|
1.40(1.35,1.45)
|
<0.0001
|
1.44(1.38,1.50)
|
<0.0001
|
1.43(1.35,1.50)
|
<0.0001
|
VAI group
|
Q1
|
1(ref)
|
|
1(ref)
|
|
1(ref)
|
|
Q2
|
1.50(1.20,1.87)
|
<0.001
|
1.44(1.14,1.82)
|
0.003
|
1.35(1.06,1.71)
|
0.02
|
Q3
|
2.84(2.39,3.37)
|
<0.0001
|
2.72(2.23,3.32)
|
<0.0001
|
2.46(1.95,3.11)
|
<0.0001
|
Q4
|
4.76(4.03,5.61)
|
<0.0001
|
4.89(4.04,5.93)
|
<0.0001
|
4.42(3.55,5.50)
|
<0.0001
|
p for trend
|
|
<0.0001
|
|
<0.0001
|
|
<0.0001
|
Model 1: non-adjusted.
Model 2: adjutesd age, gender, race.
Model 3:adjutesd age,gender,race,education,marital,PIR,smoke,alcohol,eGFR,TC,LDL,Alt,Ast,Physical Activity,Hypertension,stroke,CHD,HF.
3.3Subgroup Analysis
Subgroup analyses, as shown in Figure 3, showed that the prevalence between VAI and T2DM remained stable across age, race, eGFR, smoking, alcohol consumption, angina, stroke, and heart failure, and there was no interaction. We found a significant interaction in the subgroup of sex (male/female) (p < 0.001). In women, for every 1-unit increase in VAI, there was a 0.50-fold increase in the incidence of T2DM (OR 1.50, 95% CI 1.39-1.63).For men, each 1-unit increase in VAI was linked to a 0.32-fold increase in the odds of developing T2DM (OR 1.32, 95% CI 1.25-1.40). We also found an interaction in the subgroup of hypertensive (yes/no) (p = 0.03). In the hypertensive population, each 1-unit increase in VAI was accompanied by a 0.36-fold increase in the prevalence of T2DM (OR 1.36, 95% CI 1.28-1.45), whereas in the non-hypertensive population, each 1-unit increase in VAI was accompanied by a 0.51-fold increase in the prevalence of T2DM (OR 1.51, 95% CI 1.40-1.65). As shown in Figure 4,women were more likely to develop T2DM than men (Figure 4A) and as VAI increased nonhypertensive patients were more likely to develop T2DM than hypertensive patients (Figure 4B).