Visceral Adiposity Index and Lipid Accumulation Product as Effective Markers of Different Obesity Phenotypes in Korean Adults: A Cross-Sectional Analysis

Figures & data

Table 1 Anthropometric and Biochemical Measures According to Sex

Variables	Total	Men	Women	P-value
Age (years)	45.37±11.26	45.68±11.04	44.87±11.59	<0.001
Height (cm)	166.52±8.75	171.43±6.38	158.77±5.94	<0.001
Weight (kg)	66.41±12.23	72.54±10.29	56.71±8.08	<0.001
Body mass index (kg/m^2)	23.83±3.25	24.65±2.97	22.53±3.24	<0.001
Waist circumference (cm)	79.55±9.36	83.72±7.61	72.95±7.96	<0.001
Systolic BP (mmHg)	109.48±14.08	112.68±13.02	104.43±14.22	<0.001
Diastolic BP (mmHg)	70.51±10.31	72.94±9.88	66.67±9.80	<0.001
Total cholesterol (mg/dL)	192.97±33.99	195.29±34.08	189.30±33.52	<0.001
Triglyceride (mg/dL)	123.69±86.43	144.68±95.09	90.53±56.50	<0.001
HDL-cholesterol (mg/dL)	56.02±13.77	52.01±12.04	62.35±13.94	<0.001
LDL-cholesterol (mg/dL)	118.47±30.96	122.17±30.64	112.69±30.58	<0.001
Fasting glucose (mg/dL)	90.29±18.37	92.38±20.25	86.98±14.31	<0.001
HbA1c (%)	5.59±0.70	5.64±0.76	5.51±0.57	<0.001
Insulin (µU/mL)	4.88±3.06	5.19±3.24	4.52±2.80	<0.001
HOMA-IR	0.21±0.58	0.20±0.59	0.23±0.56	0.001
Uric acid (mg/dL)	5.34±1.47	6.05±1.28	4.21±0.95	<0.001
hs-CRP (mg/dL)	0.15±0.41	0.17±0.46	0.13±0.30	<0.001
VAI	1.50±1.29	1.67±1.38	1.24±1.08	<0.001
LAP (cm mmol/L)	25.45±25.99	31.32±28.61	16.16±17.58	<0.001

Note: Values are presented as means ± standard deviations.

Abbreviations: BP, blood pressure; HDL, high density lipoprotein; LDL, low density lipoprotein; HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model assessment for insulin resistance; hs-CRP, high sensitivity C-reactive protein; VAI, visceral adiposity index; LAP, lipid accumulation product.

Table 2 Anthropometric and Biochemical Measures According to Obesity Phenotype

Variables	Non-Obese		Obese		P-value
	Metabolically Healthy (MHNO)(n=14,240)	Metabolically Unhealthy (MUNO)(n=477)	Metabolically Healthy (MHO)(n=6796)	Metabolically Unhealthy (MUO)(n=1797)
Sex (women), n (%)*	6871 (48.3)	166 (34.8)	1545 (22.7)	453 (25.2)	<0.001
Age (years)	44.12±11.05	54.79±11.46^a	46.11±10.91^ab	50.00±11.58^abc	<0.001
Height (cm)	165.72±8.51	165.04±9.17	167.99±8.82^ab	167.74±9.42^ab	<0.001
Weight (kg)	60.39±9.07	67.72±11.49^a	75.43±9.56^ab	79.59±11.78^abc	<0.001
Body mass index (kg/m^2)	21.88±2.08	24.73±2.73^a	26.69±1.92^ab	28.20±2.56^abc	<0.001
Waist circumference (cm)	74.80±7.43	85.44±7.65^a	85.91±6.35^a	91.54±6.81^abc	<0.001
Systolic BP (mmHg)	105.96±12.95	125.19±16.60^a	112.26±12.33^ab	122.69±15.07^abc	<0.001
Diastolic BP (mmHg)	68.00±9.55	79.48±10.72^a	72.71±9.44^ab	79.68±10.71^ac	<0.001
Total cholesterol (mg/dL)	188.68±32.52	200.36±37.83^a	199.32±34.53^a	200.97±36.62^a	<0.001
Triglyceride (mg/dL)	100.55±66.75	219.03±100.79^a	137.51±83.81^ab	229.43±117.41^abc	<0.001
HDL-cholesterol (mg/dL)	59.50±13.73	44.91±11.15^a	52.61±11.75^ab	44.32±10.00^ac	<0.001
LDL-cholesterol (mg/dL)	113.75±29.55	126.10±35.10^a	126.14±31.02^a	125.18±33.10^a	<0.001
Fasting glucose (mg/dL)	87.07±15.16	113.50±33.26^a	90.77±15.21^ab	107.83±29.24^abc	<0.001
HbA1c (%)	5.48±0.58	6.39±1.24^a	5.61±0.61^ab	6.22±1.11^abc	<0.001
Insulin (µU/mL)	4.01±2.32	7.09±3.87^a	5.79±3.19^ab	7.92±4.01^abc	<0.001
HOMA-IR	0.17±0.44	0.65±1.18^a	0.22±0.58^ab	0.41±1.02^abc	<0.001
Uric acid (mg/dL)	4.98±1.36	5.45±1.49^a	5.87±1.43^ab	6.04±1.53^abc	<0.001
hs-CRP (mg/dL)	0.13±0.41	0.20±0.36^a	0.17±0.39^a	0.22±0.45^ac	<0.001
VAI	1.15±0.92	3.28±1.73^a	1.63±1.14^ab	3.33±1.97^ac	<0.001
LAP (cm mmol/L)	14.96±14.61	53.99±31.38^a	33.55±22.64^ab	70.32±39.05^abc	<0.001
MetS risk factors (%)*
Abdominal obesity	635 (4.5)	245 (51.4)	2332 (34.3)	1531 (85.2)	<0.001
High blood pressure	1078 (7.6)	271 (56.8)	924 (13.6)	924 (51.4)	<0.001
Low HDL-cholesterol	1433 (10.1)	294 (61.6)	834 (12.3)	963 (53.6)	<0.001
High fasting glucose	1110 (7.8)	313 (65.6)	873 (12.8)	1007 (56.0)	<0.001
High triglyceride	2116 (14.7)	417 (87.4)	2081 (30.6)	1486 (82.7)	<0.001

Notes: Values are presented as means ± standard deviations, *Data are presented as number (%). ^aSignificantly different from MHNO at P<0.05, ^bSignificantly different from MUNO at P<0.05, ^cSignificantly different from MHO at P<0.05.

Abbreviations: BP, blood pressure; HDL, high density lipoprotein; LDL, low density lipoprotein; HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model assessment for insulin resistance; hs-CRP, high sensitivity C-reactive protein; VAI, visceral adiposity index; LAP, lipid accumulation product; MetS, metabolic syndrome.

Figure 1 Difference between VAI (A) and LAP (B) according to obesity phenotype.

Notes: ^aSignificantly different from MHNO at P < 0.05. ^bSignificantly different from MUNO at P < 0.05. ^cSignificantly different from MHO at P < 0.05.

Abbreviations: VAI, visceral adiposity index; LAP, lipid accumulation product; MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese.

Table 3 Areas Under the Receiver Operating Characteristic Curve (AUC) for Detecting Obesity Phenotype with VAI

Obesity Phenotype		Cutoff Value	AUC (95% CI)	Sensitivity	Specificity	P-value	Youden Index
Overall	MHNO	1.31	0.728 (0.723–0.734)	71.10	62.98	<0.001	0.340
	MUNO	1.96	0.865 (0.861–0870)	83.44	78.21	<0.001	0.616
	MHO	0.92	0.597 (0.591–0.604)	73.69	44.42	<0.001	0.181
	MUO	1.83	0.877 (0.873–0.882)	83.08	78.97	<0.001	0.620
Men	MHNO	1.43	0.697 (0.690–0.705)	69.63	59.57	<0.001	0.292
	MUNO	1.78	0.829 (0.822–0.835)	86.50	68.47	<0.001	0.549
	MHO	0.86	0.554 (0.546–0.562)	79.26	33.01	<0.001	0.122
	MUO	1.83	0.849 (0.843–0.855)	83.04	74.14	<0.001	0.571
Women	MHNO	1.19	0.745 (0.736–0.754)	73.42	63.31	<0.001	0.367
	MUNO	2.10	0.918 (0.912–0.924)	86.75	88.16	<0.001	0.749
	MHO	0.93	0.620 (0.610–0.630)	65.89	55.03	<0.001	0.209
	MUO	1.58	0.921 (0.916–0.927)	88.52	81.38	<0.001	0.699

Abbreviations: VAI, visceral adiposity index; MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese.

Table 4 Areas Under the Receiver Operating Characteristic Curve (AUC) for Detecting Obesity Phenotype with LAP

Obesity Phenotype		Cutoff Value	AUC (95% CI)	Sensitivity	Specificity	P-value	Youden Index
Overall	MHNO	18.63	0.855 (0.851–0.860)	73.07	81.18	<0.001	0.542
	MUNO	25.13	0.830 (0.825–0835)	89.10	65.37	<0.001	0.544
	MHO	16.03	0.731 (0.725–0.737)	82.64	57.82	<0.001	0.404
	MUO	37.01	0.923 (0.920–0.927)	87.48	84.07	<0.001	0.715
Men	MHNO	21.56	0.817 (0.810–0.823)	69.03	78.25	<0.001	0.478
	MUNO	33.86	0.791 (0.784–0.798)	77.17	68.37	<0.001	0.455
	MHO	16.61	0.664 (0.656–0.672)	84.82	45.68	<0.001	0.305
	MUO	41.45	0.907 (0.902–0.912)	87.50	82.28	<0.001	0.697
Women	MHNO	14.42	0.883 (0.876–0.889)	77.25	82.99	<0.001	0.602
	MUNO	25.71	0.905 (0.898–0.910)	85.54	83.65	<0.001	0.691
	MHO	12.09	0.788 (0.779–0.796)	85.37	63.79	<0.001	0.491
	MUO	23.83	0.954 (0.949–0.958)	94.70	84.09	<0.001	0.788

Abbreviations: LAP, lipid accumulation product; MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese.

Table 5 Odds Ratios (OR) and 95% Confidence Intervals (CI) for Obesity Phenotype Associated with VAI

Obesity Phenotype	Men
	Quartile 1	Quartile 2	Quartile 3	Quartile 4
MHNO	1.000 (Reference)	0.610 (0.545–0.683)	0.385 (0.345–0.429)	0.179 (0.160–0.200)
MUNO	1.000 (Reference)	2.596 (0.536–8.559)	3.399 (1.985–5.499)	2.087 (1.422–9.590)
MHO	1.000 (Reference)	1.731 (1.547–1.937)	2.414 (2.165–2.692)	1.876 (1.682–2.093)
MUO	1.000 (Reference)	1.536 (0.834–2.826)	3.231 (2.254–5.290)	5.633 (3.817–10.178)
	Women
MHNO	1.000 (Reference)	0.587 (0.490–0.682)	0.380 (0.322–0.448)	0.165 (0.139–0.196)
MUNO	1.000 (Reference)	1.018 (0.994–1.048)	1.487 (0.896–4.448)	1.554 (0.831–3.928)
MHO	1.000 (Reference)	1.728 (1.468–2.035)	2.533 (2.152–2.983)	1.598 (1.324–1.929)
MUO	1.000 (Reference)	1.468 (1.387–3.842)	2.463 (1.362–6.818)	4.843 (1.140–8.988)

Note: Adjusted for age, blood pressure, total cholesterol, glucose.

Abbreviations: VAI, visceral adiposity index, MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese.

Table 6 Odds Ratios (OR) and 95% Confidence Intervals (CI) for Obesity Phenotype Associated with LAP

Obesity Phenotype	Men
	Quartile 1	Quartile 2	Quartile 3	Quartile 4
MHNO	1.000 (Reference)	0.199 (0.163–0.241)	0.067 (0.055–0.081)	0.018 (0.015–0.022)
MUNO	1.000 (Reference)	1.038 (0.827–1.049)	1.564 (0.851–4.047)	2.955 (0.958–3.986)
MHO	1.000 (Reference)	1.346 (1.199–4.399)	2.651 (1.942–4.926)	4.071 (1.917–8.893)
MUO	1.000 (Reference)	1.992 (0.990–2.994)	2.458 (1.113–3.002)	4.037 (2.335–4.887)
	Women
MHNO	1.000 (Reference)	0.136 (0.108–0.171)	0.039 (0.031–0.050)	0.011 (0.008–0.014)
MUNO	1.000 (Reference)	1.018 (1.012–1.423)	1.997 (1.009–3.002)	2.025 (1.146–3.947)
MHO	1.000 (Reference)	1.861 (1.234–4.913)	2.232 (1.903–3.988)	4.750 (1.650–8.082)
MUO	1.000 (Reference)	1.176 (1.142–3.717)	3.636 (1.427–5.512)	5.893 (2.255–10.101)

Note: Adjusted for age, blood pressure, total cholesterol, glucose.

Abbreviations: LAP, lipid accumulation product, MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese.