Acta Medica Mediterranea, 2020, 36: 813 THE COMPARISION OF VISCERAL ADIPOSITY INDEX AND ATHEROGENIC INDEX OF PLASMA IN OVERWEIGHT AND OBESE PATIENTS SELMA PEKGOR1, CEVDET DURAN2, MEHMET ALI ERYILMAZ1, UFUK BERBEROGLU3 1The Department of Family Medicine, Konya Health Application and Research Center, University of Health Sciences, Konya, Turkey - 2The Division of Endocrinology and Metabolism, The Department of Internal Medicine, Usak University, Medical School, Usak, Turkey - 3The Department of Public Health, Usak University, Medical School, Usak, Turkey ABSTRACT Introduction: Obesity and dyslipidemia are important risk factors for atherosclerosis. In this study, we aimed at comparing visceral adiposity index (VAI) levels calculated through anthropometric measurement and lipid levels with atherogenic index of plasma (AIP) levels calculated with only lipid levels in overweight and obese subjects. Materials and methods: Between 18-65 years, 157 obese patients were included. Homeostasis model assessment of insulin re- sistance (HOMA-IR), VAI and AIP levels were calculated. Results: The study was performed in 105 patients (91 women and 14 men). Regarding AIP risk levels, 9.5% (n=10) of patients were found as low-risk, 2.9% (n=3) as medium and 87.6% (n=92) as high. In high-risk group, HOMA-IR (p=0.026) and VAI (p<0.001) were found higher. VAI and AIP levels were higher among those with body mass index (BMI) (≥35 kg/m2) than those with BMI (25- 29.9 kg/m2) (p=0.009 and p=0.009, respectively). A positive correlation was detected between AIP, and HOMA-IR and VAI. Each 1-cm increase in waist circumference and each one-unit increase in body mass index (BMI) led to increases of 0.009 and 0.028 in AIP, respectively. Conclusions: As the indicators of atherosclerotic CVDs, as VAI and AIP increased, the severity of obesity increased in patients with obesity. There was a positive association between VAI and AIP, and those in high-risk group for AIP had higher VAI levels than those in low-risk group. Thanks to their easy calculation with the formula, VAI and AIP could be used to determine the atherosclerotic risk in such patients. Keywords: Atherosclerosis, atherogenic index of plasma, insulin resistance, obesity, visceral adiposity index. DOI: 10.19193/0393-6384_2020_2_127 Received May 19, 2019; Accepted January 22, 2020 Introduction mass index (BMI), waist circumference (WC), waist hip ratio (WHR) are used in the evaluation of obe- Obesity is a multifactorial chronic disease char- sity, age, gender, hydration status and ethnic factors acterized by visceral and subcutaneous adipose tis- may also affect these measurements. For example, sue accumulation, and leading to cardiometabolic high BMI values may be found in a person with high diseases. In the case of obesity, many factors such as muscle mass, or WC may be elevated in the con- lipid abnormalities, insulin resistance (IR), diabetes ditions where subcutaneous adipose tissue is high, mellitus (DM), increased inflammation, endothelial which may make these anthropometric measure- dysfunction and adipokine imbalance are known to ments inadequate in the assessment of obesity, es- cause and accelerate the development of atheroscle- pecially visceral obesity(5, 6). Again, such methods as rosis(1, 2). In the case of visceral obesity, however, the computerized tomography (CT) and dual x-ray en- incidence and severity of cardiometabolic disorders ergy absortiometry (DXA) used in order to evaluate are higher, compared to generalized obesity(3, 4). Al- visceral obesity could not be used in routine practice though such anthropometric measurements as body due to their cost, loss of time and radiation risk(7-9). 814 Selma Pekgor, Cevdet Duran et Al In many clinical studies, the levels of visceral adi- width of the buttocks. Waist/hip ratio (WHR) was posity index (VAI) obtained by the formulation of calculated by dividing the measurement of WC (cm) BMI, WC, plasma high density lipoprotein choles- to the measurement of HC (cm). BMI was also calcu- terol (HDL-cholesterol) and triglyceride (TG) levels lated as weight (kg)/height square (m2). As to BMI, were shown to be highly successful in predicting the the participants were classified as the overweight cardimetabolic risk(10-15). with BMI scores between 25-29.9 kg/m2, grade 1 Furthermore, VAI levels were shown to be more obese with BMI scores between 30-34.9 kg/m2, superior than traditional adiposity measurements in grade 2 obese with BMI scores between 35-39.9 kg/ predicting an unhealthy metabolic profiles(16). It was m2, and grade 3 obese with BMI scores of 40.0 kg/m2 also demonstrated that as a new indicator of ather- and above(21). Blood samples were drawn after 12-h ogenicity that is easy calculated logarithmically by night fasting and analyzed on the same day. Plas- the ratio of TG/HDL-cholesterol levels, the athero- ma glucose levels [normal range (NR), 70-105 mg/ genic index of plasma (AIP) increases in situations dL] were measured through the hexokinase method where the risk of atherosclerosis is increased and with Olympus AU 5800 device (Beckman Coulter superior to conventional lipid profiles in predicting Inc., CA, USA). Insulin levels [(NR), 6-27 μlU/mL] atherosclerosis and cardiovascular diseases (CVDs) were measured via the chemiluminescence method (17, 18), and AIP levels are also becoming even more in- with Immulite 2000 device (Siemens Healthcare creased, as obesity, especially abdominal obesity in- Diagnostics, Germany). The analytic sensitivity of creases(17, 18). While AIP levels lower than 0.11 were the assay was found as 2 μlU/mL. Total cholesterol reported to be associated with lower cardiovascular was spectrophotometrically measured [(NR), 110- risks in several studies, the levels between 0.11-0.24 200 mg/dL] with the device of Olympus AU 5800 were defined as intermediate risk, and those over (Beckman Coulter Inc, CA, USA). HDL-cholesterol 0.24 were shown to be associated with increased risk levels [(NR), 40-90 mg/dL] were measured with im- of CVDs (19, 20). While AIP levels are calculated, mune reaction (antigen-antibody complex) through and TG and HDL-cholesterol levels are sufficient, an Olympus AU 5800 device (Beckman Coulter Inc, BMI and WC levels are also required in the calcu- CA, USA), and TG levels [(NR), 60-150 mg/dL] lation of VAI levels, along with these parameters. were measured using a routine enzymatic method In the present study; we aimed to compare VAI and with the auto analyzer of Olympus AU 5800 device AIP levels as the indicators of atherosclerotic CVDs, (Beckman Coulter Inc, CA, USA). For calculating which could be easily calculated in overweight and low-density lipoprotein cholesterol (LDL-cholester- obese patients, and saw that as the levels of VAI and ol), the Friedewald equation was used by the formula AIP increased, the severity of obesity increased in (LDL-cholesterol=Total cholesterol-(HDL-choles- those with obesity. Thanks to their easy calculation, terol+TG/5)]. Thyroid stimulating hormone (TSH) VAI and AIP could be used to determine the risk of level (NR, 0.35-5.5 µIU/mL) was also measured atherosclerosis development in such patients. with chemiluminescence method through the device of Advia Cetaur XP (Siemens Healthcare Diagnostic, Material and method Siemens AG, Germany). Intra- and inter-assay coef- ficients of variations for TSH were 2.44 and 3.44. A total of 157 patients aged between 18-65 VAI levels were calculated for women and men by years were included into the study. They were admit- the following formula [(WC/[36.58+(1.89xBMI)] ted to the family medicine outpatient department of x[(TG(mmol/L)/0.81)x(1.52/HDL-cholester- our hospital with the complaint of obesity between ol (mmol/L))] and [(WC/39.68)+(1.88xBMI)] October 2016 and June 2017. An approval from the x[(TG(mmol/L)/1.03)x(1.31/HDL-cholesterol local ethical committee and informed written con- (mmol/L))], respectively(11). sent from each patient were obtained. Physical ex- AIP levels were calculated by taking the loga- amination and anthropometric measurements of the rithm of the ratio of TG to HDL-cholesterol as [Log patients, such as age, gender, height, weight, WC, hip (TG/HDL-cholesterol)]. Based on AIP levels, the circumference (HC) and blood pressure (BP) were risk classification was constituted as lower risk if the recorded by the researcher. Height (m) and weight calculated value was <0.1, as moderate risk if risk if (kg) were measured with underwear clothing. WC it was between 0.1-0.24 and classified as high risk if was measured as the minimum size between iliac it was >0.24 (19, 20). Used as a common marker of crest and lateral costal margin and HC at maximum IR, homeostasis model assessment-insulin resistance The comparision of visceral adiposity index and atherogenic index of plasma in overweight and obese patients 815 (HOMA-IR) index was also calculated using the for- (p=0.001), BMI (p<0.001), WC (p<0.001), HC mula (fasting glucose levels [mg/dl]×fasting insulin (p=0.03), glucose (p=0.042), TG (p<0.001), insulin levels [μU/mL]/405)(22). (p=0.043), HOMA-IR (p=0.026) and VAI (p<0.001) The patients below 18 and over 65 years of age, were determined to be higher in the high-risk group, those taking steroids or lipid-lowering drugs, under- HDL-cholesterol (p <0.001) was found to be low going liposuction, with pregnancy or breast-feeding, (Table 2). However, the levels of systolic BP, height, those with malabsorption, liver and kidney failure, total cholesterol, LDL-cholesterol and TSH were any malignancies and hypo - or hyperthyroidism, similar in both groups (Table 2).