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      Non-linear Associations Between Visceral Adiposity Index and Cardiovascular and Cerebrovascular Diseases: Results From the NHANES (1999–2018)

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          Abstract

          Objective

          To investigate associations between visceral adiposity index (VAI) and cardiovascular and cerebrovascular diseases (CCDs) in the American population from 1999 to 2018.

          Methods

          Data from the National Health and Nutrition Examination Survey (1998–2018) were analyzed in this study. Specifically, VAI scores were calculated using sex-specific equations that incorporate body mass index, waist circumference (WC), high-density lipoprotein (HDL), triglycerides (TG), and cholesterol. Weighted logistic regression analysis was conducted to assess the relationship between VAI tertile and increased risk of CCDs. Restricted cubic splines were used to evaluate the non-linear relationship between VAI and CCDs, such as heart failure, angina, heart attack, stroke, hypertension, and coronary heart disease. Sensitivity analysis was conducted, using VAI quartiles as independent variables.

          Results

          A total of 22,622 subjects aged over 20 years were included. In the fully adjusted model after controlling for covariates, the third VAI tertile was more strongly associated with CCDs than the first VAI tertile, with odds ratio (OR) and 95% confidence interval (95% CI) values for angina of 2.86, 1.68–4.85; heart attack, 1.75, 1.14–2.69; stroke, 2.01, 1.23–3.26; hypertension, 2.28, 1.86–2.78; and coronary heart disease, 1.78, 1.32–2.41; but there was no significant association with heart failure ( p > 0.05). Restricted cubic splines revealed parabolic relationships between VAI score and angina ( p for non-linear = 0.03), coronary heart disease ( p for non-linear = 0.01), and hypertension ( p for non-linear < 0.001). Sensitivity analysis indicated that the fourth VAI quartile was more strongly associated with an increased risk of angina (OR = 2.92, 95% CI, 1.49–5.69), hypertension (OR = 2.37, 95% CI, 1.90–2.97), heart attack (OR = 1.77, 95% CI, 1.09–2.88), and coronary heart disease (OR = 1.89, 95% CI, 1.24–2.86) than the first VAI quartile. VAI had superior predictive power for prevalent CCDs than other independent indicators ( p < 0.05).

          Conclusion

          Visceral adiposity index score is positively correlated with angina, heart attack, stroke, hypertension, and coronary heart disease, but not heart failure, and the relationships between VAI score and angina, hypertension, and coronary heart disease are non-linear.

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          Most cited references39

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          Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.

          Obesity, defined by a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 or more, is associated with an increased risk of death, but the relation between overweight (a BMI of 25.0 to 29.9) and the risk of death has been questioned. We prospectively examined BMI in relation to the risk of death from any cause in 527,265 U.S. men and women in the National Institutes of Health-AARP cohort who were 50 to 71 years old at enrollment in 1995-1996. BMI was calculated from self-reported weight and height. Relative risks and 95 percent confidence intervals were adjusted for age, race or ethnic group, level of education, smoking status, physical activity, and alcohol intake. We also conducted alternative analyses to address potential biases related to preexisting chronic disease and smoking status. During a maximum follow-up of 10 years through 2005, 61,317 participants (42,173 men and 19,144 women) died. Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women, in all racial or ethnic groups, and at all ages. When the analysis was restricted to healthy people who had never smoked, the risk of death was associated with both overweight and obesity among men and women. In analyses of BMI during midlife (age of 50 years) among those who had never smoked, the associations became stronger, with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons; the risk of death among underweight persons was attenuated. Excess body weight during midlife, including overweight, is associated with an increased risk of death. Copyright 2006 Massachusetts Medical Society.
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            Visceral Adiposity Index

            OBJECTIVE To individuate a novel sex-specific index, based on waist circumference, BMI, triglycerides, and HDL cholesterol, indirectly expressing visceral fat function. RESEARCH DESIGN AND METHODS Visceral adiposity index (VAI) was first modeled on 315 nonobese healthy subjects. Using two multiple logistic regression models, VAI was retrospectively validated in 1,498 primary care patients in comparison to classical cardio- and cerebrovascular risk factors. RESULTS All components of metabolic syndrome increased significantly across VAI quintiles. VAI was independently associated with both cardiovascular (odd ratio [OR] 2.45; 95% CI 1.52–3.95; P < 0.001) and cerebrovascular (1.63; 1.06–2.50; P = 0.025) events. VAI also showed significant inverse correlation with insulin sensitivity during euglycemic-hyperinsulinemic clamp in a subgroup of patients (R s = −0.721; P < 0.001). By contrast, no correlations were found for waist circumference and BMI. CONCLUSIONS Our study suggests VAI is a valuable indicator of “visceral adipose function” and insulin sensitivity, and its increase is strongly associated with cardiometabolic risk.
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              Trends in Diabetes Treatment and Control in U.S. Adults, 1999–2018

              Documenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning.
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                Author and article information

                Contributors
                Journal
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                2297-055X
                24 June 2022
                2022
                : 9
                : 908020
                Affiliations
                [1] 1School of Public Health and Management, Chongqing Medical University , Chongqing, China
                [2] 2Research Center for Medicine and Social Development, Chongqing Medical University , Chongqing, China
                [3] 3The Innovation Center for Social Risk Governance in Health, Chongqing Medical University , Chongqing, China
                [4] 4Research Center for Public Health Security, Chongqing Medical University , Chongqing, China
                [5] 5Department of Neurosurgery, West China Hospital, Sichuan University , Chengdu, China
                [6] 6Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guizhou Medical University , Guiyang, China
                [7] 7West China Hospital, Sichuan University , Chengdu, China
                [8] 8The First School of Clinical Medicine, Chongqing Medical University , Chongqing, China
                Author notes

                Edited by: Daniele Pastori, Sapienza University of Rome, Italy

                Reviewed by: Hsiang-Chun Lee, Kaohsiung Medical University, Taiwan; Natalia G. Vallianou, Evangelismos General Hospital, Greece

                *Correspondence: Mengliang Ye, yemengliang@ 123456cqmu.edu.cn

                These authors have contributed equally to this work

                This article was submitted to Cardiovascular Epidemiology and Prevention, a section of the journal Frontiers in Cardiovascular Medicine

                Article
                10.3389/fcvm.2022.908020
                9263190
                35811709
                14ff78a3-0c3e-43ab-b4f3-1c20b50589ed
                Copyright © 2022 Zhang, He, Zhang, Xiong, Shen, Yang and Ye.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 30 March 2022
                : 31 May 2022
                Page count
                Figures: 2, Tables: 4, Equations: 0, References: 40, Pages: 9, Words: 6241
                Categories
                Cardiovascular Medicine
                Original Research

                visceral adiposity index,angina,heart attack,stroke,hypertension,coronary heart disease

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