Association Between Chinese Visceral Adiposity Index and Incident Type 2 Diabetes Mellitus in Japanese Adults

Figures & data

Table 1 Baseline Characteristics of Study Population

	Female (n=7034)	Male (n=8430)	P value
Age, years	43.3 ± 8.8	44.1 ± 9.0	<0.001
BMI, kg/m^2	21.0 ± 2.9	23.0 ± 3.0	<0.001
WC, cm	71.7 ± 8.1	80.5 ± 7.9	<0.001
Smoking			<0.001
Never	6139 (87.3%)	2892 (34.3%)
Former	441 (6.3%)	2511 (29.8%)
Current	454 (6.5%)	3027 (35.9%)
Alcohol consumption			<0.001
No or minimal	6451 (91.7%)	5354 (63.5%)
Light	389 (5.5%)	1369 (16.2%)
Moderate	194 (2.8%)	1166 (13.8%)
Heavy	0 (0.0%)	541 (6.4%)
Regular exerciser	1109 (15.8%)	1600 (19.0%)	<0.001
Fatty liver	486 (6.9%)	2255 (26.7%)	<0.001
SBP, mmHg	109.4 ± 14.3	118.8 ± 14.1	<0.001
DBP, mmHg	67.6 ± 9.8	74.9 ± 10.0	<0.001
ALT, U/L	15.0 ± 12.4	24.1 ± 14.6	<0.001
AST, U/L	16.7 ± 9.0	19.8 ± 8.1	<0.001
GGT, U/L	13.6 ± 8.7	25.9 ± 21.7	<0.001
FBG, mmol/L	5.0 ± 0.4	5.3 ± 0.4	<0.001
HbA1c, %	5.2 ± 0.3	5.2 ± 0.3	<0.001
TC, mmol/L	5.1 ± 0.9	5.2 ± 0.9	<0.001
TG, mmol/L	0.7 ± 0.4	1.1 ± 0.7	<0.001
HDL, mmol/L	1.6 ± 0.4	1.3 ± 0.3	<0.001
CVAI	26.9 ± 34.3	62.8 ± 38.0	<0.001
CVAI quartiles			<0.001
Q1	2931 (41.7%)	935 (11.1%)
Q2	2103 (29.9%)	1763 (20.9%)
Q3	1306 (18.6%)	2560 (30.4%)
Q4	694 (9.9%)	3172 (37.6%)

Note: Data are expressed as mean ± standard deviation or number (%).

Abbreviations: BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase; FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; TC, total cholesterol; TG, triglycerides; HDL, high-density lipoprotein; CVAI, Chinese visceral adiposity index.

Table 2 Baseline Characteristics of Study Population According to Quartiles of CVAI and Gender

	Males				P value	Females				P value
	Q1 (≤36.171)	Q2 (36.172 ~ 62.004)	Q3 (62.005 ~ 88.068)	Q4 (≥88.069)		Q1 (≤1.860)	Q2 (1.861 ~ 23.397)	Q3 (23.398 ~ 48.395)	Q4 (≥48.396)
Age, years	40.4 ± 8.1	43.7 ± 8.8	45.4 ± 8.8	46.8 ± 8.9	<0.001	35.5 ± 6.1	41.2 ± 5.9	45.8 ± 6.9	50.5 ± 8.0	<0.001
BMI, kg/m^2	20.2 ± 1.7	22.1 ± 1.6	23.6 ± 1.7	26.3 ± 2.7	<0.001	18.6 ± 1.5	20.0 ± 1.6	21.3 ± 1.8	24.2 ± 3.1	<0.001
WC, cm	71.3 ± 3.8	77.7 ± 2.6	82.5 ± 2.6	90.3 ± 5.5	<0.001	65.2 ± 4.5	68.8 ± 5.0	72.5 ± 5.5	80.3 ± 7.8	<0.001
Smoking					<0.001					0.092
Never	846 (40.1%)	749 (35.5%)	684 (32.5%)	613 (29.1%)		1527 (86.8%)	1539 (87.5%)	1520 (86.5%)	1553 (88.3%)
Former	535 (25.4%)	600 (28.5%)	684 (32.5%)	692 (32.8%)		118 (6.7%)	122 (6.9%)	114 (6.5%)	87 (4.9%)
Current	727 (34.5%)	758 (36.0%)	739 (35.1%)	803 (38.1%)		114 (6.5%)	97 (5.5%)	124 (7.1%)	119 (6.8%)
Alcohol consumption					<0.001					0.004
No or minimal	1411 (66.9%)	1301 (61.7%)	1314 (62.4%)	1328 (63.0%)		1639 (93.2%)	1580 (89.9%)	1597 (90.8%)	1635 (93.0%)
Light	333 (15.8%)	390 (18.5%)	332 (15.8%)	314 (14.9%)		83 (4.7%)	115 (6.5%)	109 (6.2%)	82 (4.7%)
Moderate	261 (12.4%)	285 (13.5%)	310 (14.7%)	310 (14.7%)		37 (2.1%)	63 (3.6%)	52 (3.0%)	42 (2.4%)
Heavy	103 (4.9%)	131 (6.2%)	151 (7.2%)	156 (7.4%)		0 (0%)	0 (0%)	0 (0%)	0 (0%)
Regular exerciser	462 (21.9%)	442 (21.0%)	373 (17.7%)	323 (15.3%)	<0.001	236 (13.4%)	272 (15.5%)	295 (16.8%)	306 (17.4%)	0.006
Fatty liver	64 (3.0%)	289 (13.7%)	630 (29.9%)	1272 (60.3%)	<0.001	2 (0.1%)	9 (0.5%)	47 (2.7%)	428 (24.3%)	<0.001
SBP, mmHg	112.4 ± 12.2	116.9 ± 12.5	120.5 ± 13.6	125.4 ± 14.7	<0.001	102.9 ± 11.0	105.8 ± 12.2	110.0 ± 12.9	118.7 ± 15.5	<0.001
DBP, mmHg	70.0 ± 8.6	73.5 ± 9.1	76.3 ± 9.4	79.8 ± 10.0	<0.001	63.4 ± 7.7	65.5 ± 8.6	68.1 ± 9.1	73.6 ± 10.3	<0.001
ALT, U/L	18.3 ± 8.7	21.0 ± 9.9	24.7 ± 12.0	32.4 ± 20.4	<0.001	13.7 ± 6.7	13.5 ± 5.8	15.0 ± 21.0	18.0 ± 9.1	<0.001
AST, U/L	18.3 ± 7.7	18.6 ± 6.2	19.6 ± 6.6	22.7 ± 10.4	<0.001	16.0 ± 5.8	15.9 ± 4.8	16.9 ± 14.7	18.2 ± 6.9	<0.001
GGT, U/L	19.2 ± 14.6	23.6 ± 19.3	27.8 ± 23.4	32.9 ± 25.5	<0.001	12.1 ± 6.1	12.4 ± 6.3	13.5 ± 9.3	16.6 ± 11.4	<0.001
FBG, mmol/L	5.2 ± 0.4	5.3 ± 0.4	5.3 ± 0.4	5.4 ± 0.4	<0.001	4.8 ± 0.4	4.9 ± 0.4	5.0 ± 0.4	5.2 ± 0.4	<0.001
HbA1c, %	5.1 ± 0.3	5.1 ± 0.3	5.2 ± 0.3	5.2 ± 0.3	<0.001	5.1 ± 0.3	5.1 ± 0.3	5.2 ± 0.3	5.3 ± 0.3	<0.001
TC, mmol/L	4.9 ± 0.8	5.1 ± 0.8	5.3 ± 0.8	5.4 ± 0.9	<0.001	4.7 ± 0.7	4.9 ± 0.8	5.2 ± 0.8	5.6 ± 0.9	<0.001
TG, mmol/L	0.7 ± 0.3	0.9 ± 0.5	1.2 ± 0.7	1.6 ± 0.9	<0.001	0.4 ± 0.2	0.5 ± 0.2	0.7 ± 0.3	1.0 ± 0.6	<0.001
HDL, mmol/L	1.6 ± 0.4	1.4 ± 0.3	1.2 ± 0.3	1.1 ± 0.2	<0.001	1.8 ± 0.4	1.7 ± 0.4	1.6 ± 0.3	1.4 ± 0.3	<0.001

Note: Data are expressed as mean ± standard deviation or number (%).

Abbreviations: CVAI, Chinese visceral adiposity index; Q, quintiles; BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase; FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; TC, total cholesterol; TG, triglycerides; HDL, high-density lipoprotein.

Figure 1 Kaplan-Meier plots of incidence rate of T2DM for CVAI quartiles groups during follow-up. (A) In male participants; (B) In female participants.

Table 3 Correlation Between CVAI and Incident T2DM in Males

	Model 1		Model 2		Model 3
	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value
CVAI (continuous)	1.0210 (1.0182–1.0238)	<0.0001	1.0207 (1.0178–1.0236)	<0.0001	1.0133 (1.0099–1.0168)	<0.0001
CVAI quartiles
Q1	Ref.		Ref.		Ref.
Q2	1.8675 (1.0767–3.2393)	0.0262	1.7292 (0.9956–3.0033)	0.0518	1.3837 (0.7932–2.4138)	0.2527
Q3	2.9393 (1.7545–4.9242)	<0.0001	2.6286 (1.5646–4.4163)	0.0003	1.6399 (0.9595–2.8028)	0.0705
Q4	8.4693 (5.2706–13.6091)	<0.0001	7.2746 (4.5014–11.7565)	<0.0001	3.1568 (1.8697–5.3297)	<0.0001

Notes: Model 1, Unadjusted; Model 2, Adjusted for age; Model 3, Adjusted for age, smoking, alcohol consumption, exercise and fatty liver.

Abbreviations: CVAI, Chinese visceral adiposity index; T2DM, type 2 diabetes mellitus; HR, hazard ratio; CI, confidence interval.

Table 4 Correlation Between CVAI and Incident T2DM in Females

	Model 1		Model 2		Model 3
	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value
CVAI (continuous)	1.0359 (1.0304–1.0415)	<0.0001	1.0364 (1.0304–1.0423)	<0.0001	1.0246 (1.0171–1.0322)	<0.0001
CVAI quartiles
Q1	Ref.		Ref.		Ref.
Q2	1.2282 (0.3464–4.3543)	0.7502	1.1855 (0.3316–4.2383)	0.7935	1.0581 (0.2955–3.7879)	0.9309
Q3	3.2552 (1.0714–9.8900)	0.0374	3.0646 (0.9812–9.5716)	0.0539	2.1270 (0.6758–6.6945)	0.1970
Q4	16.8462 (6.1308–46.2902)	<0.0001	15.3937 (5.2384–45.2360)	<0.0001	5.8415 (1.8864–18.0894)	0.0022

Notes: Model 1, Unadjusted; Model 2, Adjusted for age; Model 3, Adjusted for age, smoking, alcohol consumption, exercise and fatty liver.

Abbreviations: CVAI, Chinese visceral adiposity index; T2DM, type 2 diabetes mellitus; HR, hazard ratio; CI, confidence interval.

Figure 2 The association between CVAI and T2DM events. A nonlinear relationship was observed after adjusting for age, smoking, alcohol consumption, exercise, and fatty liver. (A) In male participants; (B) In female participants.

Table 5 Predictive Performance of CVAI, BMI, and WC for Incident T2DM

	Index	AUC	95% CI	P value*	Best Threshold	Specificity	Sensitivity
Males	CVAI	0.7334	0.7030–0.7638		74.8838	0.6396	0.7273
	BMI	0.6838	0.6508–0.7167	<0.0001	25.0455	0.7893	0.4895
	WC	0.6995	0.6662–0.7328	<0.0001	84.65	0.7374	0.6014
Females	CVAI	0.8014	0.7531–0.8497		46.8748	0.7464	0.7471
	BMI	0.7575	0.7041–0.8108	0.0146	21.2328	0.6062	0.8046
	WC	0.7329	0.6764–0.7893	0.0002	73.45	0.6303	0.7356

Note: *P value indicates the significance of comparing with CVAI for prediction of T2DM.

Abbreviations: CVAI, Chinese visceral adiposity index; BMI, body mass index; WC, waist circumference; ROC, receiver operating characteristic curve; AUC, area under the curve; CI, confidence interval.

Figure 3 Receiver operating characteristic curves of CVAI, BMI, and WC to predict incident T2DM among study population. (A) In male participants; (B) In female participants.