Advertisement

Usefulness of the Visceral Adiposity Index in Different Populations

  • Tao-Chun Peng
    Affiliations
    Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan
    Search for articles by this author
  • Wei-Liang Chen
    Affiliations
    Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan

    Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan

    School of Medicine, National Defense Medical Center, Taipei, Taiwan

    Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
    Search for articles by this author
  • Tung-Wei Kao
    Affiliations
    Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan

    Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan

    School of Medicine, National Defense Medical Center, Taipei, Taiwan
    Search for articles by this author
      To the Editor:
      We were very interested in the study by Salazar et al
      • Salazar M.R.
      • Carbajal H.A.
      • Espeche W.G.
      • et al.
      Identification of cardiometabolic risk: visceral adiposity index versus triglyceride/HDL cholesterol ratio.
      titled “Identification of Cardiometabolic Risk: Visceral Adiposity Index Versus Triglyceride/HDL Cholesterol Ratio,” which was published in The American Journal of Medicine. The authors demonstrated that the triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio is not inferior to the visceral adiposity index for the identification of cardiovascular events. However, in another brief report by Amato et al,
      • Amato M.C.
      • Giordano C.
      • Galia M.
      • et al.
      Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk.
      the receiver operating characteristic curve analysis used to predict cardiovascular risk demonstrated significant differences in C statistics between the visceral adiposity index and the TG/HDL-C ratio (P < .005), and they concluded that the former is better.
      We do not intend to judge the differential ability of the visceral adiposity index and the TG/HDL-C ratio to predict cardiovascular risk; instead, we note that Salazar et al
      • Salazar M.R.
      • Carbajal H.A.
      • Espeche W.G.
      • et al.
      Identification of cardiometabolic risk: visceral adiposity index versus triglyceride/HDL cholesterol ratio.
      acknowledged that the relationship between the visceral adiposity index and the TG/HDL-C ratio shows a perfect positive correlation (r = 0.99). Of note, the ability to identify a “high-risk” population is highly unanimous (κ = 0.88). It is speculated that the divergent results might, at least partially, be due to the correlation between the visceral adiposity index and the TG/HDL-C ratio.
      As mentioned by the authors, the study population included only middle-aged inhabitants of Europe. This model may be unsuitable for other racial groups. This prompted us to investigate the correlation between the visceral adiposity index and the TG/HDL-C ratio in the National Health and Nutrition Examination Survey III,
      National Center for Health Statistics
      Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988-1994.
      which consisted of a representative sample of the noninstitutionalized civilian population in the United States (9492 men and 10,125 women). The exclusion criteria for enrolling subjects for the use of the visceral adiposity index were the same as those used by Salazar et al.
      • Salazar M.R.
      • Carbajal H.A.
      • Espeche W.G.
      • et al.
      Identification of cardiometabolic risk: visceral adiposity index versus triglyceride/HDL cholesterol ratio.
      However, no overt correlation between the visceral adiposity index and the TG/HDL-C ratio was found in the US population. The Pearson's r coefficient showed only a mild positive correlation in both genders (0.46 for men and 0.34 for women) (Figure). In addition, the Kappa coefficient used to identify a “high-risk” population is fair (κ = 0.33). A variant correlation between the visceral adiposity index and the TG/HDL-C ratio in different populations does indeed exist. Therefore, it is concerning if we use a population with a high correlation between the visceral adiposity index and the TG/HDL-C ratio to infer the ability of fat distribution (waist and body mass index) parameters.
      Figure thumbnail gr1
      FigureScatter plots of the relationship between the visceral adiposity index and the TG/HDL-C ratio. TG/HDL = triglyceride/high-density lipoprotein cholesterol; VAI = visceral adiposity index.

      References

        • Salazar M.R.
        • Carbajal H.A.
        • Espeche W.G.
        • et al.
        Identification of cardiometabolic risk: visceral adiposity index versus triglyceride/HDL cholesterol ratio.
        Am J Med. 2014; 127: 152-157
        • Amato M.C.
        • Giordano C.
        • Galia M.
        • et al.
        Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk.
        Diabetes Care. 2010; 33: 920-922
        • National Center for Health Statistics
        Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988-1994.
        National Center for Health Statistics, Hyattsville, MD1995

      Linked Article

      • Identification of Cardiometabolic Risk: Visceral Adiposity Index Versus Triglyceride/HDL Cholesterol Ratio
        The American Journal of MedicineVol. 127Issue 2
        • Preview
          The plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) can identify cardiometabolic risk and cardiovascular disease. The visceral adiposity index is a sex-specific index, in which measurements of body mass index and waist circumference are combined with TG and HDL-C concentrations. The current analysis was initiated to see if the visceral adiposity index would improve the ability of the TG/HDL-C to identify increased cardiometabolic risk and outcome.
        • Full-Text
        • PDF
      • The Reply
        The American Journal of MedicineVol. 128Issue 7
        • Preview
          We appreciate the interest of Peng et al in our article.1 In regard to the difference in correlation between the visceral adiposity index and plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) in our sample and theirs, we note that the visceral adiposity index is the product of 3 factors: (1) model of adipose distribution, calculated by dividing measured waist circumference by waist circumference predicted from body mass index; (2) TG (millimoles/liter) divided by 1.03 (men) or 0.81 (women); and (3) inverse of HDL-C (millimoles/liter) multiplied by 1.31 (men) or 1.52 (women).
        • Full-Text
        • PDF