Basic Anthropometric Indices and Diabetes Mellitus Type 2 in Russian Population

Obesity is one of the main risk factors for type 2 diabetes developing. The question of the advantages and disadvantages of using various anthropometric indices [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), lipid accumulation product index (LAPI), visceral obesity index (VOI)] has been under discussion lately.

Aim. To perform an analysis of anthropometric obesity indicators (BMI, WC, WHR, VOI, LAPI) depending on the presence of type 2 diabetes in the adult population of the Russian Federation.

Material and methods. The results of the study "Epidemiology of Cardiovascular diseases and their risk factors in the regions of the Russian Federation" (ESSE-RF) performed in 2012-2014 in 13  regions of the Russian Federation are included into the analysis. People aged  25-64 years (n=20878; 8058 men and 12820 women) were examined. The following indicators in people with/without type 2 diabetes were analyzed: age; sex; anthropometric indicators: height, weight, WC; smoking status  (“never smoked”, “smoked”,  “smokes  now”); alcohol consumption, which was ranked  for “never in the last year” and “a lot” (≥168 g of ethanol per week for men and ≥84 g of ethanol per week for women); the level of systolic (SBP) and diastolic (DBP) blood pressure; heart  rate (HR); levels of glucose, total cholesterol (TC), high density lipoproteins cholesterol (HDL-C), triglycerides (TG); WHR; VOI; LAPI, BMI.

Results. Levels of TC and glucose, excessive alcohol consumption, BMI were selected in a multifactor regression model in men after adjusting for age, region of residence and IVO. The same factors (SBP instead of alcohol and BMI instead of WHR were included in the model) were selected in women. VOI showed the greatest degree of association with type 2 diabetes regardless of gender after adjusting for age and region of residence (in men odds ratio 1,085; p=0.0001; in women odds  ratio 1,136; p=0.0001). Thus, VOI (predictor of type  2 diabetes in population of working age) was common to both sexes.

Conclusion. VOI has statistically significant associations with type 2 diabetes. VOI is the best surrogate marker for measuring the degree of abdominal obesity in the Russian population and can be used to determine the presence of type 2 diabetes in clinical practice. Screening for elevated VOI values in healthy individuals and patients with pre-diabetes can serve as a guide for targeted aggressive preventive interventions.

Participants of the  ESSE-RF Study: Vladivostok: Kulakova N.V., Nevzorova  V.A., Shestakova N.V., Mokshina M.V., Rodionova L.V.; Vladikavkaz: Tolparov G.V.; Vologda: Shabunova A.A., Kalashnikov K.N., Kalachikova O.N.,  Popov  A.V.; Volgograd: Nedogoda S.V., Chumachek E.V., Lediaeva A.A.; Voronezh: Chernyih T.M., Furmenko G.I., Ovsyannikova V.V., Bondarcov L.V.; Ivanovo: Belova O.A., Romanchuk S.V., Nazarova  O.A., Shutemova O.A.; Kemerovo: Barbarash O.L., Artamonova G.V., Indukaeva E.V., Mulerova T.A., Maksimov S.A., Skripchemko A.E., Cherkass  N.V., Tabakaev M.V., Danilchenko Ia.V.; Krasnoyarsk: Grinshtein Yu.I., Petrova M.M., Danilova L.K., Evsiukov A.A., Shabalin V.V., Ruph R.R., Kosinova A.A., Filonenko I.V., Baykova O.A.; Moscow: Gomyranova N.V., Oganov  R.G., Oshepkova E.V.; Orenburg: Libis R.A., Basyrova I.R., Lopina E.A.; Samara: Dupliakov D.V., Gudkova S.A., Cherepanova N.A.; St. Petersburg: Konradi A.O., Baranova E.I.; Tomsk: Trubacheva I.A., Kaveshnikov V.S., Karpov R.S., Serebriakova V.N.; Tyumen: Efanov A. Yu., Medvedeva I.V., Storozhok  M.A., Shalaev S.V.

1. Dedov I.I., Shestakova M.V., Vikulova O.K. Epidemiology of diabetes mellitus in Russian Federation:clinical and statistical report according to the federal diabetes registry. Diabetes Mellitus. 2017;20(1):13-41. (In Russ.). doi:10.14341/DM8664.

2. Yumuk V., Tsigos C., Fried M., et a l. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8:402-24. doi:10.1159/000442721.

3. WHO Obesity and Overweight. Fact sheet No.311. 2016. [cited Oct 05, 2018]. Available from:www.who.int/mediacentre/factsheets/fs311/en/.

4. Shalnova S.A., Deev A.D., Balanova Yu.A. et al. Twenty-year trends of obesity and hypertension and their associations in Russia. Twenty years trends of obesity and arterial hypertension and their association in Russia. Kardiovaskulyarnaya Terapiya i Profilaktika. 2017;16(4):4-10. (In Russ.). doi:10.15829/1728-8800-2017-4-4-10.

5. Fried M, Yumuk V., Oppert J.M., et al. European Association for the Study of Obesity. International Federation for the Surgery of Obesity - European Chapter Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Facts. 2013;6:449-68. doi:10.1159/000355480.

6. Frühbeck G., Toplak H., Woodward E., et al. Executive Committee of the European Association for the Study of Obesity Obesity: the gateway to ill health - an EASO position statement on a rising public health, clinical and scientific challenge in Europe. Obes Facts. 2013;6:117-20. doi:10.1159/000350627.

7. Dyson P.A. The therapeutics of lifestyle management on obesity. Diabetes Obes Metab. 2010;12:941-6. doi:10.1111/j.1463-1326.2010.01256.x.

8. Baranovski A.Yu., Vorohobina N.V., eds. Obesity (clinical essays). SPb.: «Izdatel'stvo Dialekt»; 2007. (In Russ.) [Барановский А.Ю., Ворохобина Н.В., ред. Ожирение (клинические очерки). СПб.: «Издательство «Диалект»; 2007.]

9. Hui Y., Zhong X., Jian-Ping F., Jin-Kui Y. Waist-to-height ratio is better than body mass index and waist circumference as a screening criterion for metabolic syndrome in Han Chinese adults. Medicine (Baltimore). 2017; 96(39):e8192. doi:10.1097/MD.0000000000008192.

10. Fujita M., Sato Y., Nagashima K., et al. Predictive power of a body shape index for development of diabetes, hypertension, and dyslipidemia in Japanese adults: a retrospective cohort study. PLoS One. 2015;10(6):e0128972. doi:10.1371/journal.pone.0128972.

11. Freemantle N., Holmes J., Hockey A., Kumar S. How strong is the association between abdominal obesity and the incidence of type 2 diabetes? Int J Clin Pract. 2008;62:1391-6. doi:10.1111/j.1742-1241.2008.01805.x.

12. Després J.P. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301-13. doi:10.1161/CIRCULATIONAHA.111.067264.

13. Millar S.R., Perry I.J., Phillips C.M. Assessing cardiometabolic risk in middle-aged adults using body mass index and waist-height ratio: are two indices better than one? A cross-sectional study. Diabetol Metab Syndr. 2015;7:73. doi:10.1186/s13098-015-0069-5.

14. Yuan M., Hsu F.C., Bowden D.W., et al. Relationships between measures of adiposity with subclinical atherosclerosis in patients with type 2 diabetes. Obesity. 2016;24:1810-8. doi:10.1002/ oby.21540.

15. Bozorgmanesh M., Hadaegh F., Azizi F. Diabetes prediction, lipid accumulation product, and adiposity measures; 6-year follow-up: Tehran lipid and glucose study. Lipids Health Dis. 2010; 9:45. doi:10.1186/1476-511X-9-45.

16. Evstifeeva S.E., Shalnova S.A., Deev A.D., et al. Diabetes risk and associations with demographic and behavioral factors in russian population: data from the ESSE-RF study. Rossijskij Kardiologicheskij Zhurnal. 2017; 9(149):13-20. (In Russ.). doi:10.15829/1560-4071-2017-9-13-20.

17. Amato MC, Giordano C, Galia M, et al., AlkaMeSy Study Group.Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33(4):920-2. doi:10.2337/dc09-1825.

18. Liu X., Wang Y., Wang C., et al. A new equation to estimate glomerular filtration rate in Chinese elderly population. PLoS ONE. 2013;8:e79675. doi:10.1371/journal.pone.0079675.

19. Liu P.J., Ma F., Lou H.P., Chen Y. Visceral Adiposity Index Is Associated with Pre-Diabetes and Type 2 Diabetes Mellitus in Chinese Adults Aged 20-50. Ann Nutr Metab. 2016;68:235-43. doi:10.1159/000446121.

20. Du T., Sun X., Huo R., Yu X. Visceral adiposity index, hypertriglyceridemic waist and risk of diabetes: the China Health and Nutrition Survey 2009. International Journal of Obesity. 2014; 38:840-847. doi:10.1038/ijo.2013.181.

21. Oh J.Y, Sung Y.A., Lee H.J. The visceral adiposity index as a predictor of insulin resistance in young women with polycystic ovary syndrome. Obesity (Silver Spring). 2013;21(8):1690-4. doi:10.1002/oby.20096.

22. Visceral Adiposity Index was a useful Predictor of Prediabetes. Exp Clin Endocrinol Diabetes. 2017; Nov 8. doi:10.1055/s-0043-120440. [Epub ahead of print]

23. Kaminskij A.V. Diabetes mellitus. Part 1. Difficult questions of diagnosis. Mezhdunarodnyj Ehndokrinologicheskij Zhurnal. 2012;3(43):43-7. (In Russ.).

24. Amato M.C., Pizzolanti G., Torregrossa V., et al. Visceral adiposity index (VAI) is predictive of an altered adipokine profile in patients with type 2 diabetes. PLoS One. 2014;20;9(3):e91969. doi:10.1371/journal.pone.0091969.

25. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis. Obes Rev. 2012;13:275-86. doi:10.1111/j.1467-789X.2011.00952.x.