Frontiers in endocrinology · 2026
Visceral fat area and visceral-to-subcutaneous fat ratio are more strongly associated with residual cholesterol than conventional anthropometric indices in adults with type 2 diabetes.
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Rao Zichen, Hua Liangyan, Mo Yiwei, Wu Zhenghao, Fang Ziru, Zhu Chunyan, Cheng Lifang, Zhang Yiming
Аннотация
BACKGROUND: Residual cholesterol (RC) is linked to cardiovascular risk, yet the optimal adiposity indices to capture this burden in type 2 diabetes (T2D) remain unclear. We compared associations of general and central adiposity indices with RC in a real-world T2D cohort.
METHODS: This cross-sectional study included 1,135 adults with T2D at a Chinese Metabolic Management Centre (2022-2025). We assessed BMI, weight, waist circumference (WC), waist-to-height ratio (WHtR), visceral fat area (VFA), subcutaneous fat area (SFA), and VFA/SFA ratio. Linear regression estimated β coefficients for RC per 1-SD increase in indices, adjusted for age, sex, HbA1c, eGFR, blood pressure, smoking, and drinking. Nonlinearity was assessed using generalized additive models and piecewise regression.
RESULTS: Across RC quartiles, patients with higher RC were more often male and current smokers and had higher BMI, WC, VFA, SFA, WHtR and VFA/SFA. In unadjusted models, all adiposity indices were positively associated with RC, but after full adjustment only VFA (β 0.1102, 95% CI 0.0186-0.2018) and VFA/SFA (β 0.1882, 95% CI 0.1010-0.2753) remained independently related to RC. When modelled in original units and quartiles, the highest VFA quartile was associated with 0.383 mmol/L (95% CI 0.131-0.636) higher RC and the highest VFA/SFA quartile with 0.562 mmol/L (95% CI 0.316-0.808) higher RC compared with the lowest quartile in fully adjusted models. A non-linear association between VFA/SFA and RC was observed, with an inflection around 0.72: below this threshold, higher VFA/SFA was strongly associated with higher RC (β 1.61, 95% CI 0.91-2.30), whereas no clear association was seen above it. Subgroup analyses showed broadly consistent associations across age, sex, BMI and HbA1c strata, without significant interactions.
CONCLUSIONS: In T2D, indices of visceral fat accumulation-particularly VFA and VFA/SFA-are more strongly associated with RC than BMI, WC, or WHtR. A VFA/SFA ratio near 0.7-0.8 may mark a critical range where visceral fat predominance is most strongly linked to RC elevation. Detailed visceral adiposity assessment may help refine RC-related risk stratification beyond traditional measures.
METHODS: This cross-sectional study included 1,135 adults with T2D at a Chinese Metabolic Management Centre (2022-2025). We assessed BMI, weight, waist circumference (WC), waist-to-height ratio (WHtR), visceral fat area (VFA), subcutaneous fat area (SFA), and VFA/SFA ratio. Linear regression estimated β coefficients for RC per 1-SD increase in indices, adjusted for age, sex, HbA1c, eGFR, blood pressure, smoking, and drinking. Nonlinearity was assessed using generalized additive models and piecewise regression.
RESULTS: Across RC quartiles, patients with higher RC were more often male and current smokers and had higher BMI, WC, VFA, SFA, WHtR and VFA/SFA. In unadjusted models, all adiposity indices were positively associated with RC, but after full adjustment only VFA (β 0.1102, 95% CI 0.0186-0.2018) and VFA/SFA (β 0.1882, 95% CI 0.1010-0.2753) remained independently related to RC. When modelled in original units and quartiles, the highest VFA quartile was associated with 0.383 mmol/L (95% CI 0.131-0.636) higher RC and the highest VFA/SFA quartile with 0.562 mmol/L (95% CI 0.316-0.808) higher RC compared with the lowest quartile in fully adjusted models. A non-linear association between VFA/SFA and RC was observed, with an inflection around 0.72: below this threshold, higher VFA/SFA was strongly associated with higher RC (β 1.61, 95% CI 0.91-2.30), whereas no clear association was seen above it. Subgroup analyses showed broadly consistent associations across age, sex, BMI and HbA1c strata, without significant interactions.
CONCLUSIONS: In T2D, indices of visceral fat accumulation-particularly VFA and VFA/SFA-are more strongly associated with RC than BMI, WC, or WHtR. A VFA/SFA ratio near 0.7-0.8 may mark a critical range where visceral fat predominance is most strongly linked to RC elevation. Detailed visceral adiposity assessment may help refine RC-related risk stratification beyond traditional measures.