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Sagittal Abdominal Diameter and Visceral Adiposity

Correlates of Beta-Cell Function and Dysglycemia in Severely Obese Women

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Abstract

Background

In the context of increasing obesity prevalence, the relationship between large visceral adipose tissue (VAT) volumes and type 2 diabetes mellitus (T2DM) is unclear. In a clinical sample of severely obese women (mean body mass index [BMI], 46 kg/m2) with fasting normoglycemia (n = 40) or dysglycemia (impaired fasting glucose + diabetes; n = 20), we sought to determine the usefulness of anthropometric correlates of VAT and associations with dysglycemia.

Methods

VAT volume was estimated using multi-slice computer tomography; anthropometric surrogates included sagittal abdominal diameter (SAD), waist circumference (WC) and BMI. Insulin sensitivity (Si), and beta-cell dysfunction, measured by insulin secretion (AIRg) and the disposition index (DI), were determined by frequently sampled intravenous glucose tolerance test.

Results

Compared to fasting normoglycemic women, individuals with dysglycemia had greater VAT (P < 0.001) and SAD (P = 0.04), but BMI, total adiposity and Si were similar. VAT was inversely associated with AIRg and DI after controlling for ancestry, Si, and total adiposity (standardized beta, −0.32 and −0.34, both P < 0.05). In addition, SAD (beta = 0.41, P = 0.02) was found to be a better estimate of VAT volume than WC (beta = 0.32, P = 0.08) after controlling for covariates. Receiver operating characteristic analysis showed that VAT volume, followed by SAD, outperformed WC and BMI in identifying dysglycemic participants.

Conclusions

Increasing VAT is associated with beta-cell dysfunction and dysglycemia in very obese women. In the presence of severe obesity, SAD is a simple surrogate of VAT, and an indicator of glucose dysregulation.

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Abbreviations

T2DM:

Type 2 diabetes mellitus

VAT:

Visceral adipose tissue

SAD:

Sagittal abdominal diameter

WC:

Waist circumference

BMI:

Body mass index

Si:

Insulin sensitivity

AIRg:

Acute insulin response to glucose

DI:

Disposition index

FSIGTT:

Frequently sampled intravenous glucose tolerance test

FPG:

Fasting plasma glucose

CT:

Computed tomography

ROC:

Receiver operating curve

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Acknowledgements

This work was supported by National Institute of Health grants R03 DK067167 and R21 DK 075745 (to NGM), K24 RR023356 (to TRZ), DK066204 (to LSP), General Clinical Research Center Grant M01 RR00039 and the Atlanta Clinical and Translational Science Institute grant UL1 RR025008 and the Veterans’ Association HSR&D awards SHP 08–144 and IIR 07–138 (to LSP). This paper was submitted in part at the Scientific Sessions of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Meeting 2010. We thank all the study participants. Adeola T. Ayeni, MD, Emory University Department of Medicine, assisted with clinical research coordination of the study participants.

Conflict of interest

No conflict of interest

Disclaimer

The findings and conclusions in this article are those of the authors and do not necessarily reflect the official position of the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Department of Nutrition Sciences, Purdue University, 700 W. State Street, Stone Hall, Room 202, West Lafayette, IN, 47907, USA

    Nana Gletsu-Miller

  2. Division of Diabetes Translation, Centers for Disease Control and Prevention, CDC Mail Stop K-10 4770 Buford Highway, NE, Atlanta, GA, 30341, USA

    Henry S. Kahn

  3. Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 2600-515 W Hastings Street, Vancouver, BC, Canada, V6B 5K3

    Danijela Gasevic

  4. Department of Surgery, Emory University School of Medicine, 7206 WMRB, 101 Woodruff Circle, Atlanta, GA, 30322, USA

    Zhe Liang

  5. Atlanta Clinical and Translational Science Institute, Emory University School of Medicine, 1364 Clifton Road, Ste GG-23, Atlanta, GA, 30322, USA

    Jennifer K. Frediani

  6. Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, A141A, Atlanta, GA, 30322, USA

    William E. Torres

  7. Department of Medicine, Emory University School of Medicine, 1364 Clifton Road, GG-23, Atlanta, GA, 30322, USA

    Thomas R. Ziegler

  8. Division of Endocrinology; Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMRB Room 1027, Atlanta, GA, 30322, USA

    Lawrence S. Phillips

  9. Department of Surgery, Emory University School of Medicine, 1364 Clifton Road, H124, Atlanta, GA, 30322, USA

    Edward Lin

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  1. Nana Gletsu-Miller
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Correspondence to Nana Gletsu-Miller.

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Gletsu-Miller, N., Kahn, H.S., Gasevic, D. et al. Sagittal Abdominal Diameter and Visceral Adiposity. OBES SURG 23, 874–881 (2013). https://doi.org/10.1007/s11695-013-0874-6

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