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Which Fat Is Best in Predicting Diabetes? 

Apr 4, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Chardae Whitner, 2020 PharmD. Candidate, Lake Erie College of Osteopathic Medicine

The possibility of visceral fat predicting hyperglycemia. 

To determine one’s abdominal obesity, visceral fat is one of the most accurate indicators. Knowing the measurements of visceral fat is pertinent because in previous research it was shown that visceral fat is associated with an increased risk for cardiovascular disease, colorectal cancer, and chronic kidney disease.  However, visceral abdominal fat area has been shown to have an association with type 2 diabetes.  With this being said, there is very little research that highlights the risk of developing diabetes and prediabetes by comparing the absolute measures of visceral and subcutaneous fat and other anthropometric measures. The study conducted by Zhang and colleagues’ goal was to analyze the strength of association between fasting plasma glucose, 2-hour postprandial glucose, hemoglobin A1c, disposition index, and nine anthropometrics measures to see which once is the best indicator for hyperglycemia.  

Participants of the study ranged in age from 25-74 years old. A total of 5,004 individuals were initially invited to participate in the study; out of those participants invited 3,350 participated. A second round of the survey was distributed which included all the original 5,004 individuals with an additional 1,579 residents invited between September 2013 to July 2014. After the second-round survey, 4,002 individuals enrolled which represents the patient population. After exclusions, a total of 3,572 participants were included for analyses.  

At baseline, participants were given a questionnaire that included basic sociodemographic information, health condition and disease history, family history, and behavioral patterns, including dietary intake, smoking, alcohol, and physical activity. The standard measurement for physical anthropometric measures was also carried out for all participants. Also, all participants underwent an unenhanced abdominal CT scan. Laboratory assessment was obtained from participants of the study. For those participants who did not have a history of diabetes, they ate ≥150 g of carbohydrates daily for at least three days and blood samples were drawn after a 10–12 h fast. Those without known diabetes underwent a 75g 2h oral glucose tolerance test. Zhang and colleagues used CT to assess the baseline visceral fat area in 3,572 participants. The independent variables that were accessed by the researchers were hemoglobin A1c, disposition index, waist circumference, waist-to-hip ratio, waist-to-height ratio, subcutaneous abdominal fat area, the ratio of visceral to subcutaneous fat, and total body weight, done at baseline.  

The researchers found the three adiposity measurements related to the highest odds of meeting the fasting plasma glucose threshold were high waist circumference, waist-to-height ratio, and waist-to-hip ratio. The odds of reaching the threshold rose by 70% when waist circumference rose by 1 standard deviation (OR = 1.7; 955 CI, 1.57-1.84), by 68% when waist-to-height ratio rose by 1 standard deviation (OR = 1.68; 95% CI, 1.55-1.82) and by 64% when waist-to-hip ratio rose by one standard deviation (OR = 1.64; 95% CI, 1.51-1.78). As for the visceral fat area, the odds of meeting the fasting plasma glucose threshold rose by 61% when the visceral fat area rose by one standard deviation (OR = 1.61; 95% CI, 1.48-1.74).  

The three adiposity measurements related to the highest odds of meeting the 2-hour postprandial glucose threshold were high waist-to-hip ratio, waist-to-height ratio, and visceral fat area. The odds of reaching the threshold rose by 83% when waist-to-hip ratio rose by 1 standard deviation (OR = 1.83; 95% CI, 1.68-2) and by 80% when waist-to-height ratio (OR = 1.8; 95% CI, 1.66-1.96) or visceral fat area (OR = 1.8; 95% CI, 1.65-1.94) rose by 1 standard deviation.  

After the reveling of the results, Zhang and his colleagues concluded that “The present study showed that visceral abdominal fat area performs no better than waist circumference and waist-to-hip ratio as an indicator of a highrisk factor for hyperglycemia among a healthy Chinese population.” They also stated that “Additional research is required to study other central obesity-related anthropometric measures and their association with diabetes.” 

Practice Pearls: 

  • Visceral abdominal fat area performs no better than waist circumference and waist-to-hip ratio as an indicator of a high-risk factor for hyperglycemia among a healthy population. 
  • This study revealed that the need for measuring abdominal fat through CT scan or other diagnostics to predict diabetes is not urgent in a healthy population.  
  • It is likely that visceral abdominal fat does not serve as a good indicator among normalweighted, healthy individuals, but could among people with obesity and older populations.   

Zhang, Fang, et al. “Is Visceral Abdominal Fat Area a Better Indicator for Hyperglycemic Risk? Results from the Pinggu Metabolic Disease Study.” Wiley Online Library, John Wiley & Sons, Ltd, 23 Feb. 2020, onlinelibrary.wiley.com/doi/full/10.1111/jdi.13217. 

Chardae Whitner, 2020 PharmD. Candidate, Lake Erie College of Osteopathic Medicine